Voice quality after carbon dioxide laser and conventional surgery for T1A glottic carcinoma

doi:10.1016/j.jvoice.2004.03.001

Journal of Voice

Volume 18, Issue 4, December 2004, Pages 545-550

https://doi.org/10.1016/j.jvoice.2004.03.001 Get rights and content

Summary

The different types of small vocal fold tumor therapy allow the preservation of respiration and deglutition; the quality of phonation is the most important criterion for the patient. The aim of the study is to compare vocal function after treatment of T1a tumors by conventional and laser cordectomy. Fifty-seven male patients were included in the study: 27 underwent conventional cordectomy using an external approach, and 30 underwent an endoscopic microscopic laser cordectomy. Videolaryngoscopy was performed for each subject, and the maximal phonation time was measured. Spectrograms were recorded, and a perturbation analysis was performed if a clear harmonic structure was visible. Voices were perceptually rated by two experienced phoniatricians using the GRBAS scale. Even though a slightly better voice was found after conventional surgery throughout the data, no statistically significant difference was measured in the two groups. The data on voice outcome per se do not indicate the selection of one surgical approach over another.

Introduction

The management of early glottic cancers is controversial. The options include external beam irradiation and endoscopic or external surgical approaches.¹ Since the first application of the carbon dioxide laser for the treatment of laryngeal carcinoma,² the laser use has become more popular in the treatment of this condition.3., 4., 5., 6. The European Laryngological Society⁷ has proposed a classification of different laryngeal endoscopic cordectomies recently. The number of recurrences and the rate of survival showed no significant difference between surgery, either laser or conventional, and radiation therapy.8., 9., 10., 11.

Each approach has its advantages and disadvantages, as shown in Table 1.8., 11., 12., 13. As all types of small vocal fold tumor therapy allow preservation of respiration and deglutition but lead to a worsening of the voice, phonation quality is considered the most important criterion. In addition, posttreatment voice results can have significant impact on the patient's quality of life and his ability to maintain employment.

We found few studies comparing functional results of laser cordectomy with that of laryngeal irradiation14., 15., 16. or with that of laryngofissure-cordectomy17., 18., 19., 20. in the literature. The aim of the present study is to compare vocal function after treatment of T1a tumors by conventional and laser cordectomy. Physical examinations as well as acoustic and perceptual measures have been used to achieve a thorough assessment of vocal function.

Section snippets

Patients

A total of 57 male patients with histologically verified invasive squamous cell carcinoma of the glottis, T1a, treated during 1991 to 1999, were involved in a retrospective study on vocal function. Thirty patients had undergone conventional cordectomy by external approach, and 27 underwent an endoscopic microscopic laser cordectomy. The external approach was used until 1995, because carbon dioxide laser was not available. In three cases, a laryngofissure-cordectomy was performed because of

Physical examination and MPT

Results of physical examination are summarized in Table 2. A large number of patients were phonating with a predominantly supraglottic component in the laser cordectomy group; supraglottic anterior–posterior compression was visible in three of them. Six of the patients phonating at a glottic level had an incomplete glottal closure. Half of the patients had a predominantly glottic phonation system in the conventional cordectomy group, and nine of them did not show evidence of insufficient

Discussion

Voice quality plays an important role in a patient's everyday activities and occupation. As the three competing treatment options for early glottic cancers—radiotherapy, laser, and conventional excision—have reported cure rates of approximately 90%,7., 8., 9., 26., 27. voice results have to be taken into account in the selection of treatment options. The voice and phonation mechanism of two groups of male patients treated surgically because of a squamous cell carcinoma of the glottis—one with

Conclusions

We wanted to analyze whether voice functional results of laser and laryngofissure cordectomy could provide guidance in the choice of a preferable technique. As reported by different authors, the existing differences in voice outcome are not statistically significant and do not indicate the selection of one surgical approach over another. Other parameters may be taken into account in the choice of the surgical technique: (1) Carbon dioxide laser is less invasive and allows for more rapid voice

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The Applicability of the Dysphonia Severity Index and the Voice Handicap Index in Evaluating Effects of Voice Therapy and Phonosurgery
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Citation Excerpt :
Part of the patients had no intervention. In most studies evaluating effects of intervention, only the results of a particular therapy for groups of patients are investigated, whereas the results for individual patients (intrasubject results) are not investigated,8,21–23 even though these intrasubject results are relevant in daily clinical practice for the evaluation of effects of intervention (eg, before and after voice therapy). A possible explanation for this lack of data is that perceptual measurements scored on categorical scales are often used and consequently calculations cannot be made.
The objective was to investigate the applicability of the Dysphonia Severity Index (DSI) and the Voice Handicap Index (VHI) in evaluating effects of intervention between groups of patients and for intrasubject differences and whether DSI and VHI are complementing measurements. Analyses of measurement data before and after intervention of 171 patients with voice disorders. The voice quality was measured objectively with the DSI. The perceived voice handicap was measured with the VHI. Three groups of patients were used: patients who had voice therapy, phonosurgery, or no intervention. DSI and VHI improved significantly after intervention in the voice therapy and the surgery group (median difference DSI 1.19 and 3.03, VHI −8 and −26, respectively). The intrasubject results were analyzed based on the test-retest variability of DSI and VHI. Significant better DSI and VHI scores after intervention were found in, respectively, 22% and 38% of the patients with voice therapy, and 56% and 78% of the patients with surgery. In the no intervention group, this was 11% and 12%. In 37% of the patients, the differences before and after intervention in DSI and VHI were in discordance. The DSI and VHI are able to show significant differences after intervention for voice disorders between groups of patients. The DSI and VHI can be used to determine a significant intrasubject result of intervention. The DSI and VHI measure each different aspects of the voice and are complementing measurements. The DSI is therefore applicable in clinical practice for objective evaluation of voice quality and the VHI for subjective evaluation of the perceived handicap by the patient self.
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Open cordectomy is nowadays a valid technique for the surgical treatment of T_1a glottic laryngeal carcinoma. Its results are comparable with those of other more recent techniques.
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Voice quality after carbon dioxide laser and conventional surgery for T1A glottic carcinoma

Summary

Introduction

Section snippets

Patients

Physical examination and MPT

Discussion

Conclusions

Otolaryngol Clin North Am

Otolaryngol Clin North Am

Otolaryngol Head Neck Surg

J Voice

J Voice

Otolaryngol Head Neck Surg

Laser surgery in the larynx. Early clinical experience with continuous CO2 laser

Ann Otol Rhinol Laryngol

Excisional biopsy in the selected management of T1 glottic cancer: a three-year follow-up study

Laryngoscope

Laser therapy for T1 glottic carcinoma of the larynx

Arch Otolaryngol Head Neck Surg

Endoscopic laser surgery

Arch Otolayngol Head Neck Surg

Selective management of early glottic cancer

Laryngoscope

Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society

Eur Arch Otorhinolaryngol

Indications and results of cordectomy for early glottic carcinoma

Otolaryngol Head Neck Surg

Prognostic factors for local control and survival in T1 squamous cell carcinoma of the glottis

Int J Radiat Oncol Biol Phys

Laryngofissure and cordectomy for glottic carcinoma limited to the mid third of the mobile true vocal cord

Laryngoscope

Laser surgery in the larynx. Early clinical experience with continuous CO₂ laser