Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps | Laryngology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
March 2018

Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 2Department of Otolaryngology–Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
  • 3Department of Otolaryngology–Head and Neck Surgery, National Taiwan University College of Medicine, Taipei, Taiwan
  • 4Master’s Program of Speech and Language Pathology, Department of Special Education, University of Taipei, Taipei, Taiwan
  • 5Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
JAMA Otolaryngol Head Neck Surg. 2018;144(3):222-230. doi:10.1001/jamaoto.2017.2899
Key Points

Questions  What are the treatment outcomes and incidence rates of adverse events associated with in-office angiolytic laser treatment with or without concurrent polypectomy for vocal polyps?

Findings  This cohort study found significant improvements in patient-reported, perceptual, and acoustic parameters in 97 patients treated with in-office 532-nm laser with or without concurrent polypectomy. Patients treated with laser and concurrent polypectomy received less laser energy, had fewer treatment-related adverse events, and less need for multiple treatment sessions than those treated with laser alone.

Meaning  In-office angiolytic laser procedures might be used as an alternative treatment of vocal polyps; concurrent polypectomy allows less laser energy delivery, reduces the need for multiple treatment sessions, and avoids the development of minor postoperative adverse events.

Abstract

Importance  In-office angiolytic laser procedures have been used successfully as an alternative treatment for vocal fold polyps; little is known in detail about the treatment outcomes and adverse events.

Objective  To examine the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps.

Design, Setting, and Participants  Retrospective cohort study at a tertiary medical center. We identified 114 consecutive patients with vocal polyps who underwent in-office angiolytic laser treatments between January 1, 2014, and August 31, 2016. After the exclusion of 17 with missing or incomplete data, 97 were enrolled.

Interventions  In-office 532-nm laser procedures with or without concurrent polypectomy.

Main Outcomes and Measures  Between 1 and 2 months after the surgical procedures, we collected the following outcome data: videolaryngostroboscopy, perceptual rating of voice quality, acoustic analysis, maximal phonation time, and subjective rating of voice quality using a visual analogue scale and 10-item voice handicap index.

Results  This study enrolled 97 patients (mean [SD] age, 45.6 [11.3] years; 48 [49%] male). The mean duration of symptoms was 10.1 months (range, 1-60 months). Twenty-nine patients (30%) had angiolytic laser procedures only, while 68 (70%) received laser with concurrent polypectomy. Both treatment modalities offered significant improvements. Only 1 patient (1%) receiving angiolytic laser with concurrent polypectomy underwent another treatment session, so this group had significantly less need for multiple treatments than those receiving laser treatment alone (6 [21%]; effect size, −1.57; 95% CI, −2.77 to −0.36). We identified 8 adverse events (8% of the cases): vocal fold edema (n = 5), vocal hematoma (n = 2), and vocal ulceration (n = 1). Patients treated with laser plus concurrent polypectomy had significantly fewer adverse events than those treated with angiolytic laser alone (2 [3%] vs 6 [21%]; effect size, 1.20; 95% CI, 0.26 to 2.13).

Conclusions and Relevance  In-office angiolytic laser procedures can be an effective alternative treatment for vocal polyps, although with possible need for multiple treatment sessions and occasional occurrence of minor postoperative adverse events. Concurrent polypectomy following laser coagulation allows less laser energy delivery and reduces the risk of postoperative adverse events and the need for additional treatment sessions.

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