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Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery.
Lasers Med Sci. 2019 Sep; 34(7):1433-1440.LM

Abstract

Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1-105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser.

Authors+Show Affiliations

Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.Student Research Group at the Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznań, Poland. piersiala@hotmail.com.Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

30762194

Citation

Jackowska, Joanna, et al. "Voice Improvement in Patients With Recurrent Respiratory Papillomatosis After Combined Treatment With Cidofovir and CO2 Laser Surgery." Lasers in Medical Science, vol. 34, no. 7, 2019, pp. 1433-1440.
Jackowska J, Wojnowski W, Hashimoto A, et al. Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery. Lasers Med Sci. 2019;34(7):1433-1440.
Jackowska, J., Wojnowski, W., Hashimoto, A., Małaczyńska, B., Piersiala, K., Świdziński, P., Wiskirska-Woźnica, B., & Wierzbicka, M. (2019). Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery. Lasers in Medical Science, 34(7), 1433-1440. https://doi.org/10.1007/s10103-019-02735-2
Jackowska J, et al. Voice Improvement in Patients With Recurrent Respiratory Papillomatosis After Combined Treatment With Cidofovir and CO2 Laser Surgery. Lasers Med Sci. 2019;34(7):1433-1440. PubMed PMID: 30762194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery. AU - Jackowska,Joanna, AU - Wojnowski,Waldemar, AU - Hashimoto,Anna, AU - Małaczyńska,Bogna, AU - Piersiala,Krzysztof, AU - Świdziński,Piotr, AU - Wiskirska-Woźnica,Bożena, AU - Wierzbicka,Małgorzata, Y1 - 2019/02/14/ PY - 2018/04/05/received PY - 2019/01/22/accepted PY - 2019/2/15/pubmed PY - 2019/10/28/medline PY - 2019/2/15/entrez KW - CO2 laser KW - Cidofovir KW - RRP KW - Vocal parameters KW - Voice quality SP - 1433 EP - 1440 JF - Lasers in medical science JO - Lasers Med Sci VL - 34 IS - 7 N2 - Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1-105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser. SN - 1435-604X UR - https://www.unboundmedicine.com/medline/citation/30762194/Voice_improvement_in_patients_with_recurrent_respiratory_papillomatosis_after_combined_treatment_with_cidofovir_and_CO2_laser_surgery_ L2 - https://dx.doi.org/10.1007/s10103-019-02735-2 DB - PRIME DP - Unbound Medicine ER -