Photoangiolytic Laser Treatment of Recurrent Respiratory Papillomatosis: A Scaled Assessment

  • Mong-Loon Kuet
    Affiliations
    School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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  • Michael J. Pitman
    Correspondence
    Address correspondence and reprint requests to Michael J. Pitman, Voice and Swallowing Institute, Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003.
    Affiliations
    Voice and Swallowing Institute, Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York, New York
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Published:October 29, 2012DOI:https://doi.org/10.1016/j.jvoice.2012.07.003

      Summary

      Objectives

      To investigate the effectiveness of unsedated office-based photoangiolytic laser surgery (UOLS) for treating recurrent respiratory papillomatosis (RRP) using the Derkay severity scale, Voice Handicap Index-10 (VHI-10), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale. Although previous studies examined the effect of UOLS on voice quality, few studies evaluated the effect on disease regression or used accepted and validated scales as outcome measures.

      Study Design

      Retrospective case series.

      Methods

      Charts were reviewed for patients who underwent UOLS for RRP (2007–2010). Twenty-one patients met the inclusion criteria. Nineteen patients underwent treatment with a 532-nm potassium titanyl phosphate laser and two with a 585-nm pulsed dye laser. The Derkay, VHI-10, and GRBAS scores of posttreatment findings were compared with those of the pretreatment findings.

      Results

      Twenty-one patients underwent 81 office procedures. Mean follow-up was 18 months. From baseline to latest follow-up, there was significant improvement in the mean Derkay score from 6.1 to 3.0 (P=0.001), VHI-10 score from 24.5 to 15.9 (P=0.04), and GRBAS score from 8.6 to 4.9 (P=0.004).

      Conclusions

      UOLS results in patient benefit from disease regression, reduced voice handicap, and improved voice quality without the risks associated with direct laryngoscopy and general anesthesia. UOLS is an effective, safe, nonexperimental treatment modality for RRP that has shifted the therapeutic paradigm while decreasing patient morbidity.

      Key Words

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      References

        • McMillan K.
        • Shapshay S.M.
        • McGilligan J.A.
        • Wang Z.
        • Rebeiz E.E.
        A 585-nanometer pulsed dye laser treatment of laryngeal papillomas: preliminary report.
        Laryngoscope. 1998; 108: 968-972
        • Zeitels S.M.
        • Akst L.M.
        • Burns J.A.
        • Hillman R.E.
        • Broadhurst M.S.
        • Anderson R.R.
        Office-based 532-nm pulsed KTP laser treatment of glottal papillomatosis and dysplasia.
        Ann Otol Rhinol Laryngol. 2006; 115: 679-685
        • Burns J.A.
        • Zeitels S.M.
        • Akst L.M.
        • Broadhurst M.S.
        • Hillman R.E.
        • Anderson R.
        532 nm pulsed potassium-titanyl-phosphate laser treatment of laryngeal papillomatosis under general anesthesia.
        Laryngoscope. 2007; 117: 1500-1504
        • Derkay C.S.
        • Malis D.J.
        • Zalzal G.
        • Wiatrak B.J.
        • Kashima H.K.
        • Coltrera M.D.
        A staging system for assessing severity of disease and response to therapy in recurrent respiratory papillomatosis.
        Laryngoscope. 1998; 108: 935-937
        • Rosen C.A.
        • Lee A.S.
        • Osborne J.
        • Zullo T.
        • Murry T.
        Development and validation of the voice handicap index-10.
        Laryngoscope. 2004; 114: 1549-1556
        • Hirano M.
        Clinical Examination of the Voice.
        Springer-Verlag, New York, NY1981 (81–84)
        • Derkay C.S.
        Task force on recurrent respiratory papillomas. A preliminary report.
        Arch Otolaryngol Head Neck Surg. 1995; 121: 1386-1391
        • Zeitels S.M.
        • Franco Jr., R.A.
        • Dailey S.H.
        • Burns J.A.
        • Hillman R.E.
        • Anderson R.R.
        Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia.
        Ann Otol Rhinol Laryngol. 2004; 113: 265-276
        • Mouadeb D.A.
        • Belafsky P.C.
        In-office laryngeal surgery with the 585nm pulsed dye laser (PDL).
        Otolaryngol Head Neck Surg. 2007; 137: 477-481
        • Dedo H.H.
        • Yu K.C.
        CO(2) laser treatment in 244 patients with respiratory papillomas.
        Laryngoscope. 2001; 111: 1639-1644
        • Franco Jr., R.A.
        • Zeitels S.M.
        • Farinelli W.A.
        • Anderson R.R.
        585-nm pulsed dye laser treatment of glottal papillomatosis.
        Ann Otol Rhinol Laryngol. 2002; 111: 486-492
        • Rees C.J.
        • Halum S.L.
        • Wijewickrama R.C.
        • Koufman J.A.
        • Postma G.N.
        Patient tolerance of in-office pulsed dye laser treatments to the upper aerodigestive tract.
        Otolaryngol Head Neck Surg. 2006; 134: 1023-1027
        • Rees C.J.
        • Postma G.N.
        • Koufman J.A.
        Cost savings of unsedated office-based laser surgery for laryngeal papillomas.
        Ann Otol Rhinol Laryngol. 2007; 116: 45-48