Subjective and objective voice outcomes after transoral laser microsurgery for early glottic cancer (original) (raw)
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Head & neck, 2017
The purpose of this study was to evaluate the recovery kinetics of voice and quality of life (QOL) over time in patients with early glottic cancer who underwent transoral laser microsurgery (TLM). A prospective cohort study was conducted in which acoustic and aerodynamic voice assessments and QOL analyses were done using health-related questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions [EORTC-QLQ-C30] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions [EORTC-QLQ-H&N35]) were administered at designated times. Most voice laboratory parameters worsened during the first month, then recovered to baseline after 6 months. The QLQ-H&N35 speech subscale was significantly improved. Among the voice laboratory parameters, pretreatment harmonics-to-noise ratio was an independent predictor (P = .041) for improvement on the speech subscale at the endpoint. De...
Journal of Clinical Medicine
Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO2 transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year rec...
Shiraz E-Medical Journal
Background: This study aimed to assess differences in the quality of voice results of open frontolateral partial laryngectomy with imbrications laryngoplasty and transoral laser microsurgery in T1b glottic carcinoma. Methods: In this randomized clinical trial, 20 patients with T1b glottic cancer who were candidates for surgery were randomly (using the blocked randomization method) assigned to schedule for frontolateral partial laryngectomy with imbrications laryngoplasty (n = 7) or transoral laser microsurgery (Va extended cordectomy) (n = 10). The objective and subjective voice results were assessed using voice analysis parameters (jitter, shimmer, harmonics to noise ratio, and maximum phonation time). The Voice Handicap Index (VHI) questionnaire was used with 30 statements consisting of three domains including functional, physical, and emotional aspects of voice disorders. Results: No statistically significant differences were noted between laser surgery and open procedure in objective voice analysis parameters. The voice was significantly disturbed after both procedures but subjective analysis of the voice by the VHI questionnaire showed more statistically significant patients' satisfaction in the laser group. The mean VHI was 77.29 ± 8.51 after vertical hemilaryngectomy and 65.60 ± 13.08 after laser cordectomy that was significantly lower in the latter procedure (P = 0.042). Conclusions: Despite the imbrications of laryngoplasty in open surgery, no statistically significant differences were noted in objective voice parameters. However, more patients' satisfaction was noted regarding voice in laser surgery. When considering modality, we need to assess factors such as individual anatomic factors, complete tumor exposure (depth of tumor in anterior commissure), professional needs, quality of life, and cost-effectiveness. With regard to the semi-invasive nature of laser use and more patients' satisfaction based on the VHI questionnaire, this method is prioritized in comparison with the surgical procedure as vertical hemilaryngectomy.
European Archives of Oto-Rhino-Laryngology, 2019
Purpose Longitudinal studies in laryngeal cancer can provide clinicians information about short-term and long-term functional outcomes, like quality of life (QoL) and voice outcome. This information is important when counseling patients or choosing a primary treatment modality. The present study assessed long-term (2 years) QoL and voice outcome in patients with extended T1 and limited T2 glottic carcinoma treated with transoral CO 2 laser microsurgery (TLM) (unilateral type III or bilateral type II resections). Methods Three questionnaires were administered: the Voice Handicap Index (VHI), the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ)-C30, the EORTC QLQ-HN35. A perceptual voice evaluation at six different time points was conducted: preoperatively, and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Fluctuations over time were investigated. Results Sixty-one patients were included in the analysis. Patients reported high-level functioning and low symptom scores 2 years postoperatively. Gender significantly affected the VHI scores at 2 years (mean VHI scores: female 8.7 vs. male, 23.9; p = 0.023). The major improvement in VHI scores was observed within the first 6 months. The tumor stage (T1a, T1b, and T2) significantly impacted the grade (mean scores at 2 years: 1.0, 1.9, and 1.7; p = 0.001). These scores stabilized at 6 months. Conclusions Patients show good long-term QoL with low symptom scores, a low voice handicap, and mild to moderate dysphonia, 2 years postoperatively. Scores stabilize at 6 months and provide a clear indication of status at 1 and 2 years.
International Archives of Otorhinolaryngology, 2021
Introduction Early glottic cancer (EGC) is associated with a high cure rate. Hence, patients and physicians also focus on the impact of the proposed treatment on the speaking function of the preserved larynx. Objectives The present study assessed the impact of single-modality treatment (transoral laser microsurgery [TLM], or radiotherapy) or combination therapy for EGC on postinterventional voicing and explored factors which might explain the related perceptions. Methods A total of 108 patients filled in the voice handicap index 10 questionnaire, 1 and 2 years postinterventionally. Non-parametric tests were used for the respective statistical analyses. Results Sixty-four patients were treated with TLM, 15 with radiotherapy, and 29 with both modalities. Transoral microsurgery and radiotherapy were associated with postinterventional dysphonia, which attenuated between the first and second postintervention year (p = 0.000). No association between sociodemographic parameters and the att...