Office‐Based Treatment of Vocal Fold Polyps and Reinke's Edema: A Rational Comparison With Suspension Laryngoscopy

Abstract

ObjectiveBenign laryngeal lesions have traditionally been treated through suspension laryngoscopy under general anesthesia (GA). Recently, the development of operative videoendoscopes coupled with photoangiolytic lasers has allowed clinicians to treat these conditions in the outpatient clinic. We report our experience in the office‐based (OB) setting for the treatment of patients affected by vocal fold polyps (VFPs) and Reinke's edema (RE), comparing it to patients treated under GA.MethodsA retrospective analysis was conducted on patients affected by VFP or RE. A 445 nm diode blue laser was used through the operative channel of a flexible video‐endoscope for OB procedures, while GA surgeries were carried out with cold steel instrumentation. The Voice Handicap Index‐10 (VHI‐10) represented the primary outcome. Endoscopic outcomes, duration, and morbidity of the procedures were investigated as secondary outcomes.ResultsA total of 153 patients were retrospectively enrolled. 52 were treated in an OB setting, while 91 underwent GA. Regarding patients with RE, both the OB and GA cohorts showed a significant improvement in VHI‐10 (from 12.7 to 2.6 and 19.5 to 5.1, respectively; p < 0.001), as did those with VFPs (from 11.8 to 2.3 and 15.9 to 2.9 respectively; p < 0.001). No differences were found when comparing VHI‐10 in the OB and GA cohorts. The mean procedural time of OB treatment (4.9 min) was significantly shorter than GA (37.1 min). No adverse events were reported.ConclusionOur data demonstrate the efficacy and safety of the OB setting. For selected patients, OB treatments offer comparable vocal outcomes, favorable morbidity, and reduced operation times, making them an appealing alternative to the traditional approach.Level of Evidence3 Laryngoscope, 133:2665–2672, 2023

Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps

“…Most recently, Filauro and colleagues evaluated 143 patients with BVFLs. 23 Notably, 88 patients had VF polyps treated by either OR microlaryngoscopy (37) or office-based photoangiolysis (51) using the 445-nm diode blue laser. The study evaluated VHI-10 and subjective evaluation of mucosal wave (rated as either "intact" or "impaired") at baseline and a single follow-up time of 2-4 months.…”

“…Changes in patient-reported outcomes measures are perhaps the most widely studied when evaluating responses to voice treatment. Significant improvement in Voice Handicap Index scores after treatment of BVFLs with both microlaryngoscopy 3,10,[22][23][24][25][26][27][28][29][30][31] and office-based laser treatment 22,23,[32][33][34] have been well documented. The primary outcome measure in this study is the VHI-10 score at 1 month after treatment.…”

“…These findings are consistent with previously published results in which improvements in VHI-10 after intervention ranged from 5.0 to 12.6 points at 2 weeks, 10.6 to 12.1 points at 6 weeks, and 10.0 to 13.0 points at 8 weeks. 22,23,32,33 Though the difference between VHI-10 score in the treatment groups at 1 month was selected as the primary outcome measure in the design of this study, there may be significant differences between groups earlier during recovery. Within the study cohort, there is a nonsignificant difference in the absolute VHI-10 score at the first postoperative visit (1-2 weeks), with a mean of 14.00 in the OR group and 10.39 in the KTP group.…”

Transoral Flexible Laser Surgery of the Larynx with Blue Laser

“…The results of this investigation agree with published reports on blue laser therapy for vocal fold lesions. Several papers have presented case series of patients treated with blue laser in-office such as Miller et al’s [ 18 ], Hamdan et al’s [ 19 ], Ghanem et al’s [ 20 ], Filauro et al’s [ 21 ] and Hamdan et al’s [ 22 , 23 ]. They have demonstrated the usefulness of this laser resecting laryngeal lesions in consultation in awake patients.…”

“…Campos et al [ 17 ] have reported the use of this blue laser on 38 patients under general anesthesia, using direct laryngoscopy techniques (Transoral Flexible Laser Surgery (TOFLS), showing it is a reliable tool to perform minimally invasive surgeries in the operating room using TOFLS techniques. Similarly, Miller et al [ 18 ], Hamdan et al [ 19 ], Ghanem et al [ 20 ], Filauro et al [ 21 ] and Hamdan et al [ 22 , 23 ] presented several case series of patients treated with in-office blue laser (TNFLS), concluding that this tool is effective for many laryngeal pathologies.…”