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lesions, with the latter demonstrating preserved or improved
mucosal wave and glottic closure after treatment.
14,15
Pitman et al evaluated the effect of office-based KTP laser
treatment in 7 patients with Reinke’s edema and found sig-
nificant improvement in subjective measures for voice qual-
ity as well as a trend toward improvement in objective
measures.
13
Although these studies provided important initial support
for the use of office-based photoangiolytic laser therapy in the
management of Reinke’s edema, they are limited by a modest
sample size and measurement of few objective voice para-
meters. As such, larger studies addressing the safety, tolerabil-
ity, and voice outcomes for this approach are necessary. We
report on 19 patients who underwent office-based photoangio-
lytic laser treatment of Reinke’s edema. We hypothesized that
no complications would occur, patients would tolerate the pro-
cedure, Voice Handicap Index would decrease, and objective
voice parameters would move toward the normal ranges.
Specifically, we hypothesized that posttreatment assessment
would show increased fundamental frequency range, decreased
jitter, decreased phonation threshold pressure, and increased
maximum phonation time (MPT).
Materials and Methods
Subjects
Approval for this study was obtained from the University of
Wisconsin Health Sciences Institutional Review Board. The
study was designed as a retrospective case series of patients
treated at the University of Wisconsin–Madison. Patient data
were obtained from the University of Wisconsin–Madison
Voice and Swallow Outcomes Database. Appropriate patients
were identified by the University of Wisconsin–Madison Voice
and Swallow Outcomes database manager by cross-matching
diagnosis with the existence of a procedure, and data extraction
was performed by a separate researcher. All patients presented
to the University of Wisconsin Hospital and Clinics between
January 2007 and November 2013 and underwent voice analysis
by a speech-language pathologist, as well as evaluation and
treatment by an otolaryngologist. All patients with documented
Reinke’s edema who underwent at least 1 office-based treatment
were considered for inclusion. Patients were excluded if they
were
\
18 years old, had a history of laryngeal malignancy, had
a history of a neurolaryngologic disorder (eg, cerebrovascular
accident, amyotrophic lateral sclerosis, vocal tremor, or recurrent
laryngeal or superior laryngeal nerve injury), had a history of
airway stenosis, or were unable to provide consent.
Treatment
All procedures were performed in a clinic setting without seda-
tion. Patients are positioned sitting upright. Local nasal
anesthesia is obtained by placing 4% lidocaine and 0.05%
oxymetazoline-soaked sponges in the nasal cavities. A flexible
endoscope is passed through the nasal cavity for indirect visua-
lization of the endolarynx. Laryngeal anesthesia is obtained by
instilling 3 aliquots of 0.5 mL of 4% lidocaine through the
working channel of the endoscope during sustained phonation
(the ‘‘laryngeal gargle’’). The laser fiber is passed through the
working channel and advanced until the tip of the fiber is
visualized. Laser energy is then applied to the involved tissues.
Of note, tissue ablation is not desired during these procedures;
rather, enough energy is applied to blanch the superficial tis-
sues (
Figure 1
). Importantly, no immediate reduction is tissue
size is desired. Twelve procedures were performed using the
KTP laser, and 13 were performed using the PDL.
Experimental Data
Patient demographics, chief complaint, and social history
were collected. Endoscopic findings and physician impres-
sion were recorded to ensure diagnosis, as well as to docu-
ment unilateral versus bilateral involvement. Treatment of
laryngopharyngeal reflux disease was also documented.
Reported complications and patient tolerance data were also
collected by extracting physician documentation from the
University of Wisconsin–Madison Voice and Swallow
Outcomes database. This included whether a procedure was
truncated, as well as the number of procedures performed
for each patient and whether operative interventions were
ultimately required. Minor complications included nasal or
pharyngeal pain, minor nosebleed, and vasovagal events.
Major complications included need for emergent airway
intervention, hospitalization or presentation to the emer-
gency department after treatment, airway bleeding, airway
stenosis, reported myocardial infarction or cerebrovascular
accident, and extralaryngeal tissue injury. Patients were
requested to report complications at follow-up visits; how-
ever, our data set did not allow for standardized follow-up
of all possible complications.
Objective voice measures were obtained as part of a stan-
dard comprehensive voice assessment. Aerodynamic para-
meters included MPT, mean airflow rate, laryngeal resistance,
phonation threshold pressure, and mean peak air pressure.
Aerodynamic parameters were measured using the Phonatory
Aerodynamic System (model 6600, KayPENTAX, Montvale,
New Jersey); the device was calibrated prior to each use
according to manufacturer specifications. For MPT, patients
produced a sustained /a/ at a modal pitch for as long as possible;
this was repeated 3 times, and the longest trial taken as the
Figure 1.
Endoscopic view of glottis immediately before (A) and
immediately after (B) treatment. Note the superficial blanching
without reduction in tissue mass immediately following application
of laser energy.
Otolaryngology–Head and Neck Surgery 152(6)
64