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Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps.
JAMA Otolaryngol Head Neck Surg. 2018 03 01; 144(3):222-230.JO

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.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan. Department of Otolaryngology-Head and Neck Surgery, National Taiwan University College of Medicine, Taipei, Taiwan. Master's Program of Speech and Language Pathology, Department of Special Education, University of Taipei, Taipei, Taiwan.Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan. Department of Otolaryngology-Head and Neck Surgery, National Taiwan University College of Medicine, Taipei, Taiwan. Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan. Department of Otolaryngology-Head and Neck Surgery, National Taiwan University College of Medicine, Taipei, Taiwan.Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29346486

Citation

Lin, Yu-Hsuan, et al. "Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps." JAMA Otolaryngology-- Head & Neck Surgery, vol. 144, no. 3, 2018, pp. 222-230.
Lin YH, Wang CT, Lin FC, et al. Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps. JAMA Otolaryngol Head Neck Surg. 2018;144(3):222-230.
Lin, Y. H., Wang, C. T., Lin, F. C., Liao, L. J., Lo, W. C., & Cheng, P. W. (2018). Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps. JAMA Otolaryngology-- Head & Neck Surgery, 144(3), 222-230. https://doi.org/10.1001/jamaoto.2017.2899
Lin YH, et al. Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps. JAMA Otolaryngol Head Neck Surg. 2018 03 1;144(3):222-230. PubMed PMID: 29346486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps. AU - Lin,Yu-Hsuan, AU - Wang,Chi-Te, AU - Lin,Feng-Chuan, AU - Liao,Li-Jen, AU - Lo,Wu-Chia, AU - Cheng,Po-Wen, PY - 2018/1/19/pubmed PY - 2019/9/19/medline PY - 2018/1/19/entrez SP - 222 EP - 230 JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg VL - 144 IS - 3 N2 - 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. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/29346486/Treatment_Outcomes_and_Adverse_Events_Following_In_Office_Angiolytic_Laser_With_or_Without_Concurrent_Polypectomy_for_Vocal_Fold_Polyps_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2017.2899 DB - PRIME DP - Unbound Medicine ER -