291 / 412
Safety and Tolerability
There were no reported minor or major complications. Five
procedures had to be truncated due to patient intolerance.
Voice Outcomes
Summary data are presented in
Table 1
. After treatment,
dysphonia severity index changed significantly, with a move
toward normal voice (
P
= .003). Phonatory frequency range
increased (
P
= .003), and percent jitter decreased (
P
=
.004). Phonation threshold pressure decreased (
P
= .049),
but there were no significant changes in MPT, mean airflow
rate, or laryngeal resistance. Total VHI (
P
\
.001) as well
as each component of the VHI decreased significantly after
treatment (functional:
P
\
.001; physical:
P
= .001; emo-
tional:
P
= .005;
Figure 3
).
Energy Delivered
Energy delivery data were available on 21 procedures per-
formed to treat bilateral disease. Average energy delivered
per procedure was 132
6
68 J (range, 23-268 J). There was
no meaningful difference between the amounts of energy
delivered with each laser. For KTP procedures, 126
6
63 J
(range, 47-246 J) were applied; for PDL procedures, 128
6
75 J (range, 23-268 J) were applied. In 2 procedures for uni-
lateral disease, 108 and 45 J were delivered with the KTP
and PDL, respectively.
Discussion
We present a retrospective case series of patients who under-
went office-based laser treatment of Reinke’s edema. To our
knowledge, this study is the largest such series to date.
The increasingly common use of lasers in otolaryngology
reflects a general trend toward rendering treatment in the
office rather than the operating suite. Office-based treatments
offer several advantages. In addition to avoiding the risks of
general anesthesia, including myocardial infarction and
stroke, unsedated office-based treatment of patients with
airway limitations allows the patient to remain in control of
his or her own airway throughout the procedure, reducing the
risk of airway compromise during induction of general
anesthesia. Office procedures cost less,
18
require less time,
and avoid the potential complications of microlaryngoscopy,
such as dental injury and dysgeusia.
19
Moreover, attempting
Table 1.
Voice Outcome Data.
a
Parameter
Pretreatment
Posttreatment
No.
P
Value
Dysphonia severity index
2
7.0
6
3.3
2
3.0
6
2.6
12
.003
Acoustic
Maximum F
0
290
6
53
482
6
272
12
\
.001
Minimum F
0
110
6
35
119
6
95
12
.147
Frequency range
180
6
67
363
6
295
12
.003
Percent jitter
4.05
6
2.83
1.66
6
1.10
12
.004
Aerodynamic
Maximum phonation time
8.77
6
4.28
9.29
6
3.71
13
.674
Phonation threshold pressure
8.21
6
3.10
6.69
6
2.59
4
.049
Mean airflow rate
0.30
6
0.07
0.27
6
0.13
4
.536
Laryngeal resistance
47.36
6
16.97
46.46
6
24.29
4
.918
Peak pressure
14.04
6
4.58
10.92
6
4.07
4
.069
Voice handicap index
Functional
18
6
10
12
6
9
14
\
.001
Physical
21
6
8
15
6
10
14
.001
Emotional
17
6
10
11
6
10
14
.005
Total
56
6
26
37
6
27
14
\
.001
Abbreviation: F
0
, fundamental frequency.
a
Data are presented as mean
6
standard deviation. Complete data sets with measurements of all parameters were not available for every subject; sample
size is therefore variable.
Figure 3.
Each component, as well as the total Voice Handicap
Index, decreased significantly after treatment. Bar height represents
average reported voice handicap; error bars represent standard
deviation.
Otolaryngology–Head and Neck Surgery 152(6)
66