Systematic Review of Recurrence Rates of Benign Vocal Fold Lesions Following Surgery

Gocal, Wiktoria A.; Tong, Jane Y.; Maxwell, Philip J.; Sataloff, Robert T.

doi:10.1016/j.jvoice.2022.10.015

Cited by 4 publications

(6 citation statements)

References 46 publications

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“…However, different vocal fold lesions may respond differently to laser surgery. For example, vocal fold cysts were ablated and marsupialized instead of removed in TNLS group, which may account for the higher overall cyst recurrence rate in this study (13.8%) compared to historic cohort (2.2%–8.7%) 26 . Several factors in this study may affect the treatment outcomes of vocal cord cysts.…”

Section: Discussionmentioning

confidence: 89%

Randomized Controlled Trial of Awake Transnasal Laser‐Assisted Surgery for Benign Laryngeal Lesions

Tam,

Leung,

Lee

et al. 2024

The Laryngoscope

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ObjectiveTo compare functional and cost‐effectiveness of awake transnasal laser assisted‐surgery versus microlaryngeal surgery for benign laryngeal lesions.MethodsThis was a prospective non‐inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block‐randomized to receive either awake transnasal laser‐assisted surgery or microlaryngeal surgery, with post‐operative follow‐up in a multidisciplinary voice clinic for 1‐year. Primary outcome was Voice Handicap Index (VHI‐30). Secondary outcomes included operation time, complications, length of stay, peri‐operative discomfort, recurrence, and medical costs.ResultsSixty‐one patients were randomized to either awake transnasal laser‐assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI‐30 score over time and had comparable post‐operative VHI‐30. Awake transnasal laser‐assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost‐analysis showed a significantly lower hospital cost for awake transnasal laser‐assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120).ConclusionAwake transnasal laser‐assisted surgery was safe, functionally non‐inferior, as measured by VHI‐30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri‐operative discomfort and medical costs.Level of EvidenceLevel 2 Laryngoscope, 2024

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Section: Discussionmentioning

confidence: 89%

Randomized Controlled Trial of Awake Transnasal Laser‐Assisted Surgery for Benign Laryngeal Lesions

Tam,

Leung,

Lee

et al. 2024

The Laryngoscope

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“…The benefit of a DPI with more true positive mild cases is thought to outweigh the risk of increased false positives 41 . For example, false positives can be easily identified via in‐office laryngoscopy, 42 whereas the damage associated with false negatives has the potential of worsening over time 43,44 . Early detection of phonotrauma should help mitigate the possibility of developing more severe damage to vocal fold tissue through referrals to voice therapy 45 and thus potentially minimize the need for laryngeal surgery 46 .…”

Section: Discussionmentioning

confidence: 99%

“…41 For example, false positives can be easily identified via in-office laryngoscopy, 42 whereas the damage associated with false negatives has the potential of worsening over time. 43,44 Early detection of phonotrauma should help mitigate the possibility of developing more severe damage to vocal fold tissue through referrals to voice therapy 45 and thus potentially minimize the need for laryngeal surgery. 46 This could be an especially helpful screening tool in occupations with high risks of phonotrauma such as teachers, call center workers, and singers.…”

Section: Discussionmentioning

confidence: 99%

Detecting Mild Phonotrauma in Daily Life

et al. 2023

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ObjectiveThe aim of this study was to gain quantitative insights into the role of daily voice use associated with mild phonotrauma via the Daily Phonotrauma Index (DPI), a measure derived from neck‐surface acceleration magnitude (NSAM) and difference between the first two harmonic magnitudes (H1 − H2).MethodsAn ambulatory voice monitor recorded weeklong voice use for 151 female patients with phonotraumatic vocal hyperfunction (PVH) and 181 female vocally healthy controls. Three laryngologists rated phonotrauma severity from each patient's laryngoscopy. Mixed generalized linear models evaluated the accuracy, sensitivity, and specificity of the original DPI trained on all patients versus a mild DPI version trained on only patients rated with mild phonotrauma. Individual contribution of NSAM and H1 − H2 to each DPI model was also evaluated.ResultsReliability across the laryngologists' phonotrauma ratings was moderate (Fleiss κ = 0.41). There were 70, 69, and 12 patients with mild, moderate, and severe phonotrauma, respectively. The mild DPI, compared to the original DPI, correctly classified more patients with mild phonotrauma (Cohen's d = 0.9) and less controls (d = −0.9) and did not change in overall accuracy. H1 − H2 contributed less to mild phonotrauma classification than NSAM for mild DPI.ConclusionsCompared with the original DPI, the mild DPI exhibited higher sensitivity to mild phonotrauma and lower specificity to controls, but the same overall classification accuracy. These results support the mild DPI as a promising detector of early phonotrauma and that NSAM may be associated with early phonotrauma, and H1 − H2 may be a biomarker associated with vocal fold vibration in the presence of lesions.Level of EvidenceLevel 4, case–control study Laryngoscope, 2023

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“…В ходе операции бригада хирургов при удалении карциномы гортаноглотки использовала СО 2 -лазер вместо традиционных холодных инструментов и отметила выраженные резекционные качества лазерной установки. Однако разрез первых лазерных аппаратов, производимый за счет непрерывной подачи энергии инфракрасной части оптического спектра, отличался протяженной зоной коагуляционных изменений, что требовало избирательности применения высокоэнергетического хирургического инструмента для снижения рубцевания тканей в отдаленном периоде [14,15]. За более чем 60-летнюю историю лазерной медицины аппараты значительно изменились и приобрели надежную систему охлаждения, процессор и микроманипулятор для работы в дистантном режиме [16].…”

Section: материалы и методыunclassified

“…Благодаря полностью автоматизированным параметрам луча и хорошей управляемости микроманипулятора обеспечивается точность движений в операционном поле (гортани). Помимо дистантного способа доставки излучения в операционное поле с использованием зеркальных систем, как традиционно работает СО 2 -лазер, также существует доставка лазерной энергии по оптическим волоконным световодам [14,15].…”

Section: материалы и методыunclassified

Microsurgery of chronic laryngeal diseases using fiber optic lasers. A review

Krivopalov,

Shamkina,

Glushchenko

2023

Consilium Medicum

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Background. The treatment of chronic diseases of the larynx is an urgent issue. Chronic larynx masses account for up to 5570% of the upper respiratory tract proliferative diseases. The incidence of vocal apparatus disorders is stable due to increased load on the vocal apparatus, neuro-emotional stress, non-compliance with voice hygiene (smoking, alcohol consumption), nasal and pharyngeal inflammatory diseases, sensibilization, and gastrointestinal disorders. Dysphonia, voice timbre changes, and vocal fatigue are presented in 712% of otorhinolaryngologist patients. Delayed treatment of chronic larynx diseases can lead to upper respiratory obstruction, reduced exercise and self-care tolerance, and disablement in people with voice and speech professions. Aim. To address current treatment methods for chronic diseases of the larynx. Modern surgical and non-surgical treatments of chronic larynx diseases aim to restore voice quality and respiratory function. Over the past 50 years, laser-assisted phonosurgery has gained popularity due to the many benefits of biological tissue exposure to electromagnetic energy and low rates of intra- and postoperative complications. Materials and methods. The literature review was performed using electronic medical libraries and professional printed papers. According to local and foreign data, laryngeal laser surgery is highly precise, minimally invasive, associated with no blood loss, and highly effective. Historically, CO2 laser has been used for the longest time in laryngeal surgery. Modern medical technology has recently introduced surgical systems with novel technicalities for clinical use. In such devices, the laser energy is transmitted through a flexible optical fiber instead of a mirror system, as in the CO2 laser, which has made new surgical high-energy systems more affordable for equipping medical institutions. Currently, the following fiber-optic laser systems are most often used to treat chronic diseases of the larynx: potassium-titanyl-phosphate, diode laser, and "blue" laser with a wavelength of 445 nm. Results. The literature review and analysis of surgical treatment outcomes using fiber-optic laser devices in patients with chronic larynx diseases showed high safety and effectiveness of modern treatments, providing fast recovery of voice and respiratory function. Conclusion. The development of laser devices, including domestic ones, with new wavelengths, makes it possible to work in contact mode in an inert gas environment, which opens up new opportunities for phonosurgery.

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Systematic Review of Recurrence Rates of Benign Vocal Fold Lesions Following Surgery

Cited by 4 publications

References 46 publications

Randomized Controlled Trial of Awake Transnasal Laser‐Assisted Surgery for Benign Laryngeal Lesions

Randomized Controlled Trial of Awake Transnasal Laser‐Assisted Surgery for Benign Laryngeal Lesions

Detecting Mild Phonotrauma in Daily Life

Microsurgery of chronic laryngeal diseases using fiber optic lasers. A review

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