Voice Quality Outcomes After Transoral CO₂ Laser Cordectomy: A Longitudinal Prospective Study

Abstract

Objective To evaluate the evolution of voice quality in patients after type I-VI transoral CO2 laser cordectomy (TLC) by using validated voice outcome measures over a 12-month period. Study Design Prospective uncontrolled study. Setting Monocenter study. Methods Patients with laryngeal carcinoma who were eligible for type I-IV TLC were prospectively recruited from a tertiary medical center. The following outcomes were assessed throughout the 12-month posttreatment period: Voice Handicap Index (VHI), GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain), maximal phonation time, fundamental frequency (F0), F0 standard deviation, percentage jitter, percentage shimmer, noise-to-harmonic ratio, and speech fluency. Analyses were performed considering 2 groups of cordectomies: type I-III vs IV-VI. Results A total of 131 patients completed the evaluations, totaling 76 type I-III and 55 type IV-VI cordectomies. In type IV-VI, breathiness and maximal phonation time significantly worsened from pretreatment to 1 month posttreatment ( P < .05). In the type I-III cordectomy group, VHI, shimmer, roughness, breathiness, and strain significantly improved from pretreatment to 3 months posttreatment, while VHI, F0 standard deviation, shimmer, jitter, grade of dysphonia, roughness, breathiness, and strain improved from baseline to 6 months. Assessments at 12 months posttreatment revealed significant improvements for VHI, shimmer, jitter, noise-to-harmonic ratio, grade of dysphonia, roughness, breathiness, and strain. In the type IV-VI group, VHI significantly improved from baseline to 3, 6, and 12 months posttreatment. Strain improved at 6 and 12 months while roughness improved from baseline to 12 months. Maximal phonation time significantly worsened over the 12-month evaluation period. Conclusion The effect of TLC on voice quality depends on its type. VHI was identified as the most indicative tool of voice changes irrespective of TLC type.

Evaluation of Voice Therapy After Type I, II, and V Cordectomy for Early-Stage Laryngeal Cancer Using Subjective Voice Quality Assessment Tools

“…Maximum voice quality outcome is achieved 6 months after TLM, according to the findings of the vast majority of studies exploring the progression of voice quality. 1 In their recent paper, Kinberg et al 2 report the long-term voice outcomes following type I, II, and V cordectomy using objective and subjective voice quality evaluation tools. In particular, they emphasize that voice outcomes following type V cordectomy are similar to those following type I and type II cordectomy, and that superficial anterior or posterior commissure resection may not significantly affect voice outcome.…”

Laryngeal Cancer Surgery: History and Current Indications of Transoral Laser Microsurgery and Transoral Robotic Surgery

“…Type I–III cordectomies are associated with adequate voice quality outcomes, while type IV–VI cordectomies may lead to significant dysphonia. In all cases, the voice quality outcomes improved from 6 to 12 months post-TLM with better improvements in young individuals compared with elderly patients [ 35 ]. The patients with dysphonia post-type IV-VI TLM may benefit from autologous fat medialization to improve the voice [ 36 ].…”

“…Speech therapy is another important postoperative way to improve the voice quality. Subjective and objective voice quality parameters may be used in the follow-up to measure the effectiveness of speech therapy [ 35 ].…”