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Selective lateral laser thyroarytenoid myotomy for adductor spasmodic dysphonia

Conclusion: Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.

from the Journal of Laryngology and Otology

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Laser Reduction Glottoplasty for Managing Androphonia After Failed Cricothyroid Approximation Surgery

Methods
The voices of three male-to-female transsexuals, two constitutional androphonic females, and one patient with ambiguous genitalia assigned to the female phenotype were deemed to be unimproved after CTA. The patients underwent laser reduction glottoplasty (LRG) surgery tailored to each case between 2001 and 2005. Vocal outcomes were evaluated according to fundamental frequency (FF), satisfaction status, voice-related quality of life (V-RQOL) measures, and ratings of recorded voices by 10 blinded listeners after 12 months postoperatively.

Results
The LRG provided an additional mean gain of 45.17 ± 8.47 Hz (mean ± standard deviation) in the FF, equal to 4.36 ± 0.84 semitones. The mean FF increased significantly (P < 0.05) from 158.33 ± 12.14 Hz preoperatively to 203.50 ± 13.34 Hz postoperatively. All patients reported satisfactory female quality in their voices and greetings with female salutations in nonvisual communications. Their voice-related quality of life (V-RQOL) measures were high and significantly elevated (P < 0.05) after LRG. The masculine voice-quality ratings significantly shifted to feminine in the listeners' assessment. No major complications were observed during follow-up, with the exception of mild vocal fold edema that disappeared by 8 weeks postoperatively.

Conclusions
LRG can be used in androphonic cases that fail to obtain a high-pitched feminine voice after CTA.

from the Journal of Voice

Voice Outcome in T1a Midcord Glottic Carcinoma

from Archives of Otolaryngology–Head and Neck Surgery

Objective To compare voice quality after radiotherapy or endoscopic laser surgery in patients with similar T1a midcord glottic carcinomas according to a validated multidimensional protocol.

Design Retrospective cohort study.

Setting University cancer referral center.

Patients Two cohorts of consecutive patients willing to participate after treatment for primary T1a midcord glottic carcinoma with laser surgery (18 of 23 eligible) or radiotherapy (16 of 18 eligible).

Main Outcome Measures Posttreatment voice quality was evaluated according to a multidimensional voice protocol based on validated European Laryngological Society recommendations, including perceptual, acoustic, aerodynamic, and stroboscopic analyses, together with patient self-assessment using the Voice Handicap Index.

Results Approximately half of the patients had mild to moderate voice dysfunction in the perceptual analysis (53% [8 of 15] in the radiotherapy group and 61% [11 of 18] in the laser surgery group) and on the Voice Handicap Index (44% [7 of 16] in the radiotherapy group and 56% [10 of 18] in the laser surgery group). The voice profile in the laser surgery group was mainly breathy; in the radiotherapy group, it was equally breathy and rough, with a trend for more jitter in the acoustic analysis. There was no statistical difference in the severity of voice dysfunction between the groups in any of the variables.

Conclusions Endoscopic laser surgery offers overall voice quality equivalent to that of radiotherapy for patients with T1a midcord glottic carcinoma, although specific voice profiles may ultimately be different for the 2 modalities. We believe that endoscopic laser surgery is the preferred treatment in these patients because it provides oncologic control similar to that of radiotherapy and the additional benefits of lower costs, shorter treatment time, and the possibility of successive procedures.

Functional vocal results after CO2 laser endoscopic surgery for glottic tumours

from the Journal of Laryngology and Otology

Abstract
Introduction: Vocal results after endoscopic cordectomy have not yet been well defined. The aim of this study was to assess the vocal function of patients who had undergone CO2 laser cordectomy.

Design: Retrospective, observational and control group study, conducted in a tertiary care medical department.

Methods: One hundred and thirty-five male patients (age range 36–83 years) underwent different types of endoscopic cordectomy. Forty age-matched, euphonic male subjects were selected as controls. Patients were classified according to the main site of the phonatory neo-glottis. Outcome measures were maximum phonation time, vocal intensity and harmonic/noise ratio. Mann–Whitney and rank Spearman tests were used for statistical analysis.

Results: Findings indicated statistically significant differences for all parameters, comparing patients and controls (p<0.001), and a direct positive relation between type of functional compensation and outcome measures in the study patients (p<0.001).

Conclusions: The results indicate that functional compensation and outcome measures were related, and that no functional compensation enabled the study patients to achieve a voice quality comparable with that of controls.