HSC Section 6 Nov2016 Green Book

Reprinted by permission of Otolaryngol Head Neck Surg. 2015; 152(6):1075-1081.

Original Research—Laryngology and Neurolaryngology

Otolaryngology– Head and Neck Surgery 2015, Vol. 152(6) 1075–1081 American Academy of Otolaryngology—Head and Neck

Office-Based Photoangiolytic Laser Treatment of Reinke’s Edema: Safety and Voice Outcomes

Surgery Foundation 2015 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815577104 http://otojournal.org

Ian J. Koszewski, MD 1 , Matthew R. Hoffman, PhD 1 , W. Greg Young, MD 1 , Ying-Ta Lai, MD 1 , and Seth H. Dailey, MD 1

degeneration. Patients are generally middle-aged women, and they have voice complaints of abnormally low speaking pitch and a rough voice quality. 1 Multiple risk factors have been identified, including tobacco use, vocal abuse, and laryngo- pharyngeal reflux. 2-5 Critical to preventing progression of the disease and managing the dysphonia are nonsurgical strategies, such as smoking cessation, voice therapy, and treatment of underlying laryngopharyngeal reflux. 1,6 When a nonsurgical approach is inadequate, surgery is employed. Traditional surgi- cal options have focused on mucosal microflap elevation with removal of tissue, 7,8 microdebridement, 9 carbon dioxide laser ablation, 10,11 and cold knife cytoreduction. 12 Recently, photoangiolytic laser treatment has been pro- posed as an alternative treatment. 13-16 Unlike traditional methods that involve the physical removal of tissue, the potassium titanyl phosphate (KTP) laser and pulsed dye laser (PDL) target oxyhemoglobin and are thought to address the vascular congestion characteristic of Reinke’s edema. Importantly, both the KTP and the PDL have flex- ible fibers that can be passed through a flexible endoscope for office-based interventions, thus avoiding risks associated with general anesthesia. 17 Performing procedures in the office rather than the operating room has several notable advantages, including decreased cost 18 and avoidance of the potential complications of microlaryngoscopy, such as dental injury and dysgeusia. 19 Office-based use of lasers for the treatment of Reinke’s edema has gained popularity with the advent of improved instrumentation and evidence that the procedures are safe and cost-effective. Koufman et al and Sheu et al reported large series demonstrating support for the use of photoan- giolytic lasers in the treatment of an array of laryngeal 1 Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA This article was presented at the 2014 AAO-HNSF Annual Meeting & OTO EXPO; September 21-24, 2014; Orlando, Florida. Corresponding Author: Seth H. Dailey, MD, Division of Otolaryngology–Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Clinical Science Center-H4, Madison, WI 53792-3284, USA. Email: dailey@surgery.wisc.edu

No sponsorships or competing interests have been disclosed for this article.

Abstract Objective. To evaluate the safety, tolerability, and voice outcomes of office-based photoangiolytic laser treatment of Reinke’s edema.

Study Design. Case series with chart review.

Setting. Academic medical center.

Subjects and Methods. We performed a retrospective analysis of patients undergoing office-based laser treatment of endoscopy-proven Reinke’s edema. Safety and tolerability were evaluated by reviewing complications. Voice outcomes were analyzed by comparing pre- and postprocedural acoustic, aero- dynamic, and Voice Handicap Index measurements. Complete data sets were not available for all subjects; sample size for each parameter is reported with the corresponding result. Results. Nineteen patients met inclusion criteria. There were no minor or major complications. Five procedures were truncated due to patient intolerance. Phonatory frequency range increased (n = 12, P = .003), while percent jitter decreased (n = 12, P = .004). Phonation threshold pressure decreased after treatment (n = 4, P = .049). Voice Handicap Index also decreased (n = 14, P \ .001). Conclusion. This study represents the largest series of patients undergoing office-based photoangiolytic laser treat- ment specifically for Reinke’s edema. Our data suggest that this is a safe and effective modality to treat dysphonia asso- ciated with Reinke’s edema, although patient intolerance of the procedure may represent a barrier. Keywords Reinke’s edema, photoangiolytic laser, office-based treat- ment, voice Received October 24, 2014; revised January 14, 2015; accepted February 20, 2015. R einke’s edema is a benign disease of the true vocal folds, characterized by edema and vascular congestion within Reinke’s space, leading to diffuse polypoid

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