85 / 412
MPT. For mean airflow rate, laryngeal resistance, and peak air
pressure, patients produced 3 /pa/ syllable trains at comfortable
pitch and loudness; the first and last /pa/ token within each train
were removed and the average values computed. For phonation
threshold pressure, patients produced 3 /pi/ syllable trains, each
beginning with a soft whisper, followed by incremental
increases in subglottal pressure until comfortable voicing was
achieved; the lowest subglottal pressure at which phonation
occurred was recorded as the phonation threshold pressure.
Acoustic parameters included minimum and maximum funda-
mental frequency, phonatory frequency range, and percent jitter.
Acoustic data were recorded using the Computerized Speech
Lab (model 4150B, KayPENTAX) and Multi-Dimensional
Voice Program (model 5105, KayPENTAX). For fundamental
frequency values, patients performed ascending and descending
glides on the vowel /a/ and were instructed to achieve the
lowest and highest frequencies possible, inclusive of falsetto
phonation; this was repeated 3 times and the extrema recorded.
Phonatory frequency range was calculated as the difference
between maximum and minimum fundamental frequency. For
percent jitter, patients produced a stable /a/. Dysphonia severity
index was calculated as described by Wuyts et al.
20
Subjective
voice changes were quantified using pre- and postprocedural
scores from the Voice Handicap Index.
21
This instrument mea-
sures the impact of one’s voice in 3 separate subcategories:
functional, physical, and emotional. Finally, total energy deliv-
ered was collected.
Although a standardized clinical protocol is followed for
collection of voice measures at clinical visits, occasionally
not all voice measures are available in the database.
Accordingly, a complete data set including all voice para-
meters was not available for every subject. Analyses were
performed using the data that were available, and the
number of subjects included in each analysis has been speci-
fied. A subject was not included in a given analysis of effi-
cacy if he or she did not have a measurement of that
parameter before and after the procedure.
Statistical Analysis
Evaluation of treatment efficacy was performed using
paired
t
tests. If data did not meet assumptions for para-
metric testing, a Wilcoxon-Mann-Whitney matched pairs
signed-rank test was performed. All tests were 2-tailed with
a significance level of
a
= 0.05. As complete data sets were
not available for all subjects, sample size for each parameter
is reported with the corresponding result.
Results
Subject Characteristics
Nineteen patients underwent 25 in-office endoscopic laser
treatments of Reinke’s edema between January 2007 and
November 2013. All but 1 patient was a woman, and all
were smokers at the time of presentation. Average age at pre-
sentation was 53.9
6
7.7 years (range, 43-67 years). All but
1 patient had bilateral involvement, with 1 demonstrating
polypoid change affecting only 1 vocal fold. Sample pre- and
posttreatment images are provided in
Figure 2
.
Figure 2.
Sample pre- and posttreatment images from 2 patients. A, subject 1: A1, pretreatment, normal inspiration; A2, posttreatment,
normal inspiration; A3, posttreatment, vocal fold abduction. B, subject 2: B1, pretreatment, vocal fold abduction; B2, pretreatment, normal
inspiration; B3, posttreatment, vocal fold abduction; B4, posttreatment, normal inspiration.
Koszewski et al
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