1. Vocal Outcome After Cordectomy by Transoral CO 2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions.
- Author
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Printz T, Mehlum CS, Godballe C, Iwarsson J, Pedersen SG, Christensen JH, Jørkov AS, and Grøntved ÅM
- Subjects
- Humans, Male, Middle Aged, Female, Prospective Studies, Aged, Treatment Outcome, Adult, Time Factors, Recovery of Function, Voice Disorders physiopathology, Voice Disorders etiology, Voice Disorders surgery, Voice Disorders diagnosis, Longitudinal Studies, Disability Evaluation, Aged, 80 and over, Speech Acoustics, Speech Production Measurement, Acoustics, Microsurgery adverse effects, Voice Quality, Lasers, Gas therapeutic use, Laryngeal Neoplasms surgery, Laryngeal Neoplasms physiopathology, Laryngeal Neoplasms pathology, Vocal Cords surgery, Vocal Cords physiopathology, Laser Therapy adverse effects, Carcinoma in Situ surgery, Carcinoma in Situ physiopathology, Carcinoma in Situ pathology
- Abstract
Objectives: This study investigates vocal outcome after cordectomy by transoral CO
2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy., Study Design: Prospective, longitudinal, quasi-experimental time series., Methods: Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings., Results: Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy., Conclusion: Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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