Assessment of Voice Quality After Carbon Dioxide Laser and Microdebrider Surgery for Reinke Edema *,†,‡Paweł Krzysztof Burduk, *Małgorzata Wierzchowska, *Monika Orzechowska, §Wojciech Kazmierczak, ska, *xTorun and yzBydgoszcz, Poland and §Katarzyna Pawlak-Osin Summary: Objectives. Surgery of Reinke edema requires reduction of the degenerated superficial lamina propria and preservation of the vibratory epithelium. Material and Methods. Sixteen patients were included for microdebrider and 10 patients for carbon dioxide (CO2) laser surgery. Vocal analysis was performed before and at 1 and 3 months after surgery. Subjective rating of voice quality was completed by the grade, roughness, breathiness, asthenia, and strain scale. The objective assessment was conducted by Multi-Dimensional Voice Program software. Results. We found consistent improvement in all parameters both in CO2 laser and microdebrider group. The normalization of all parameters were statistically better after microdebrider surgery. The most statistically significant improvements were accounted in reduction in grade of hoarseness, roughness, and asthenia and acoustic analysis. Conclusions. Microdebrider is a useful and safe tool for Reinke edema treatment. The oscillatory cutting knife and low suction protect lamina propria resulting in better vibratory function. Key Words: Reinke edema–Larynx–CO2 laser–Microdebrider–Voice quality.
INTRODUCTION Reinke edema is an inflammatory diffuse disorder of the superficial lamina propria of the vocal folds.1–4 Its pathogenesis is strongly associated with heavy smoking, frequently with laryngopharyngeal reflux and endocrinological aberrations.1,2,5–7 The low grade of the edema severity is usually treated nonsurgically. The management includes smoking cessation and voice therapy.1,2,5,6 When the voice is not satisfactory or the respiratory problems occurred, the surgery is mandatory.1,2,8 The goals of Reinke edema surgery are reduction of the degenerated superficial lamina propria and preservation of the vibratory epithelium.1,2,5,9–11 Edema reduction with minimal mucosal damage is the gold strategy recommended for optimal voice recovery.5,7,9,12 The most popular treatment method of Reinke edema is carbon dioxide (CO2) laser surgery. Using the micromanipulator or scanning micromanipulator, the surgery is more sufficient with better voice quality.1,8,13,14 Nevertheless, the cold instruments have still been used in microlaryngoscopic surgery. The cold instruments could be used as a combination of CO2 laser or microdebrider surgery.1,2,5 Reinke edema treatment with microdebrider is a minimal invasive technique, make the surgery more safe.2,5,15 The multifunctional handpiece, which can be used to irrigation, resection, and suction, is very useful in resecting the superficial lamina propria pathology.2,5,15
Accepted for publication July 28, 2014. From the *Department of Otolaryngology and Laryngological Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland; yBiomedical Engineering, University of Technology and Life Sciences, Bydgoszcz, Poland; zMechanical Engineering Department, University of Technology and Life Sciences, Bydgoszcz, Poland; and the xDepartment of Pathophysiology of Hearing and Balance System, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland. Address correspondence and reprint requests to Pawe1 K. Burduk, Department of Otolaryngology and Laryngological Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru n, Poland, Sklodowska-Curie 9 Str, 85-094 Bydgoszcz, Poland. E-mail: [email protected] Journal of Voice, Vol. -, No. -, pp. 1-4 0892-1997/$36.00 Ó 2014 The Voice Foundation http://dx.doi.org/10.1016/j.jvoice.2014.07.016
The aim of this study was to compare the functional results of voice quality of Reinke edema surgery using CO2 laser and microdebrider. MATERIAL AND METHODS Twenty-six female patients with Reinke edema were included in this prospective clinical trail. The institutional review board approval No 232/2010 was obtained before the study. We have obtained written informed consents from all participants. The patients were randomly assigned to the study group I or II using an envelope method. Sixteen patients, mean age 54.4 years, were included for microdebrider surgery (group I), whereas 10 patients, mean age 55.1 years, for CO2 laser surgery (group II). All the subjects had a history of cigarette smoking, more than 20 cigarettes/day. The exclusion criteria included any previous larynx surgery, active reflux disease, and cigarette smoking. All patients were required to strictly cease smoking at least 4 weeks before the operation and after the surgery. Reinke edema was diagnosed by endoscopic and stroboscopic examination. The classification described by Yonekawa16 was used to grade the severity of the disease. The histopathology examination was done in all cases. Vocal analysis and larynx endoscopy were performed before and at 1 and 3 months after surgery. Subjective rating of voice quality was completed by two examiners (M.W. and M.O.) blinded to the study population using the grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. The objective assessment was conducted by Multi-Dimensional Voice Program (MDVP) software (IRIS otolaryngology, Medi.com, Wroc1aw, Poland). Fundamental frequency (F0), jitter, shimmer, noiseto-harmonic ratio (NHR), and phonation time were recorded. All patients were instructed to pronounce the vowel ‘‘a’’ for at least 3 seconds in a quiet room. Maximum phonation time (MPT) was assessed during sustained vowel ‘‘a’’ following deep inspiration at conversational pitch and loudness level by using a stopwatch. The stroboscopic images were recorded before and at 1 and 3 months after surgery and three observers
2
Journal of Voice, Vol. -, No. -, 2014
TABLE 1. GRBAS Mean Evaluation for CO2 Laser Surgery (n ¼ 10) Scale Presurgery Postsurgery 1 mo Postsurgery 3 mo P
G
R
B
A
S
3.4 1.94 1.69
INTRODUCTION Reinke edema is an inflammatory diffuse disorder of the superficial lamina propria of the vocal folds.1–4 Its pathogenesis is strongly associated with heavy smoking, frequently with laryngopharyngeal reflux and endocrinological aberrations.1,2,5–7 The low grade of the edema severity is usually treated nonsurgically. The management includes smoking cessation and voice therapy.1,2,5,6 When the voice is not satisfactory or the respiratory problems occurred, the surgery is mandatory.1,2,8 The goals of Reinke edema surgery are reduction of the degenerated superficial lamina propria and preservation of the vibratory epithelium.1,2,5,9–11 Edema reduction with minimal mucosal damage is the gold strategy recommended for optimal voice recovery.5,7,9,12 The most popular treatment method of Reinke edema is carbon dioxide (CO2) laser surgery. Using the micromanipulator or scanning micromanipulator, the surgery is more sufficient with better voice quality.1,8,13,14 Nevertheless, the cold instruments have still been used in microlaryngoscopic surgery. The cold instruments could be used as a combination of CO2 laser or microdebrider surgery.1,2,5 Reinke edema treatment with microdebrider is a minimal invasive technique, make the surgery more safe.2,5,15 The multifunctional handpiece, which can be used to irrigation, resection, and suction, is very useful in resecting the superficial lamina propria pathology.2,5,15
Accepted for publication July 28, 2014. From the *Department of Otolaryngology and Laryngological Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland; yBiomedical Engineering, University of Technology and Life Sciences, Bydgoszcz, Poland; zMechanical Engineering Department, University of Technology and Life Sciences, Bydgoszcz, Poland; and the xDepartment of Pathophysiology of Hearing and Balance System, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland. Address correspondence and reprint requests to Pawe1 K. Burduk, Department of Otolaryngology and Laryngological Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru n, Poland, Sklodowska-Curie 9 Str, 85-094 Bydgoszcz, Poland. E-mail: [email protected] Journal of Voice, Vol. -, No. -, pp. 1-4 0892-1997/$36.00 Ó 2014 The Voice Foundation http://dx.doi.org/10.1016/j.jvoice.2014.07.016
The aim of this study was to compare the functional results of voice quality of Reinke edema surgery using CO2 laser and microdebrider. MATERIAL AND METHODS Twenty-six female patients with Reinke edema were included in this prospective clinical trail. The institutional review board approval No 232/2010 was obtained before the study. We have obtained written informed consents from all participants. The patients were randomly assigned to the study group I or II using an envelope method. Sixteen patients, mean age 54.4 years, were included for microdebrider surgery (group I), whereas 10 patients, mean age 55.1 years, for CO2 laser surgery (group II). All the subjects had a history of cigarette smoking, more than 20 cigarettes/day. The exclusion criteria included any previous larynx surgery, active reflux disease, and cigarette smoking. All patients were required to strictly cease smoking at least 4 weeks before the operation and after the surgery. Reinke edema was diagnosed by endoscopic and stroboscopic examination. The classification described by Yonekawa16 was used to grade the severity of the disease. The histopathology examination was done in all cases. Vocal analysis and larynx endoscopy were performed before and at 1 and 3 months after surgery. Subjective rating of voice quality was completed by two examiners (M.W. and M.O.) blinded to the study population using the grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. The objective assessment was conducted by Multi-Dimensional Voice Program (MDVP) software (IRIS otolaryngology, Medi.com, Wroc1aw, Poland). Fundamental frequency (F0), jitter, shimmer, noiseto-harmonic ratio (NHR), and phonation time were recorded. All patients were instructed to pronounce the vowel ‘‘a’’ for at least 3 seconds in a quiet room. Maximum phonation time (MPT) was assessed during sustained vowel ‘‘a’’ following deep inspiration at conversational pitch and loudness level by using a stopwatch. The stroboscopic images were recorded before and at 1 and 3 months after surgery and three observers
2
Journal of Voice, Vol. -, No. -, 2014
TABLE 1. GRBAS Mean Evaluation for CO2 Laser Surgery (n ¼ 10) Scale Presurgery Postsurgery 1 mo Postsurgery 3 mo P
G
R
B
A
S
3.4 1.94 1.69
