Predictive Factors Affecting the Outcomes Of angiolytic Laser-Assisted Glottoplasty for Sulcus Vocalis.

OBJECTIVE: Glottoplasty using an angiolytic laser is an option for the surgical treatment of sulcus vocalis. In this study, we sought to evaluate the clinical outcomes of using a 532-nm diode laser in sulcus vocalis patients and to identify predictive factors of improved voice outcomes after angiolytic laser-assisted glottoplasty. METHODS: A total of 66 patients with sulcus vocalis who underwent laser-assisted glottoplasty with a 532-nm diode laser were included in this study. RESULTS: 3 months after surgery, GRBAS scores, patient-reported outcome measures, fundamental frequency (F0), jitter percent, and noise-to-harmonic ratio decreased significantly, while cepstral peak prominence (CPP) of vowel and sentence production increased. Patients with auditory-perceptual improvements showed greater improvement in the Voice Handicap Index (VHI) scores, F0, and CPP of vowel and sentence production compared to those with no improvement. While young male patients with preoperatively high F0 were predicted to have favorable outcomes, the type of sulcus vocalis was not predictive of treatment outcomes. Patients treated with lower laser power showed better improvement in the VHI scores postoperatively than those who received higher laser power per vocal fold. Combined injection laryngoplasty with laser glottoplasty was effective in lowering the F0, especially in male patients with high F0. CONCLUSION: A 532-nm diode laser is useful for treating sulcus vocalis. Young male patients and individuals with preoperatively high F0 showed better voice outcomes after laser glottoplasty. Laser power and combined injection laryngoplasty are considered to affect improvement in the VHI and lowering F0 after laser glottoplasty in sulcus vocalis.

Cotton Ball Self-Retraction Technique: A Novel Surgical Method Used During Microflap Dissection.

OBJECTIVES/HYPOTHESIS: Microsurgical removal with a microflap technique via direct laryngoscopy is considered the primary treatment option for vocal cysts. However, the microflap technique is technically difficult and challenging. Therefore, we developed the "cotton ball self-retraction" technique to aid in vocal cyst surgery and reduce the cyst rupture incidence. This study aimed to evaluate the efficacy of this technique in microflap dissection for vocal cysts by comparing its treatment outcomes with those of the conventional technique as well as investigate the rate of recurrence using a retrospective chart review. STUDY DESIGN: A retrospective review. METHODS: We reviewed the medical records of 169 patients who underwent surgery with the microflap technique for vocal cysts from December 2006 to December 2017. The patients were divided into two groups: 78 patients underwent laryngomicrosurgery using the conventional microflap technique (group A), whereas the remaining 91 patients underwent surgery with the microflap technique with cotton ball self-retraction (group B). The voice outcomes and operative data of the two groups were retrospectively reviewed and compared. RESULTS: The cyst ruptured intraoperatively in 42 of 78 (53.8%) patients in group A and 17 of 91 (18.6%) patients in group B. Recurrence during the follow-up period was detected in 9 of 78 (11.5%) patients in group A and 2 of 91 (2.19%) patients in group B. The degrees of improvement in assessed voice parameters were not significantly different between the groups. CONCLUSION: The cotton ball technique allows accurate and effective dissection during microflap surgery for intracordal cysts. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2553-E2557, 2021.

Acoustic Psychometric Severity Index of Dysphonia (APSID): Development and Clinical Application.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to explore the predictability of the Korean version of the Voice Activity and Participation Profile (K-VAPP) scores and acoustic measures for perceived severity of voice disorders. Furthermore, usefulness of the index derived from the multivariate formula as a screening tool for voice disorders was explored and compared with that of the Cepstral Spectral Index of Dysphonia (CSID). METHODS: A total of 150 patients with various voice disorders (42 males and 108 females, age = 45.15 ± 15.15 years) and matched 50 normal controls (14 males and 36 females, age = 44.78 ± 13.70 years), participated in the study. Correlates of perceived overall severity were explored by a stepwise regression analysis with regards to demographic information (age, gender, and professional voice use), jitter, shimmer, and noise-to-harmonic ratio of vowel samples, cepstral peak prominence (CPP), L/H spectral ratio, and their standard deviations of sentence and vowel samples, and psychometric measures of the K-VAPP. Using the ROC curve analysis, the area under curve (AUC) of the novel index derived from the regression equation and the CSID were compared and the cut-off score of the index was obtained. RESULTS: A significant portion (adjusted R square = 79.0%) of the overall severity perceived by clinicians was predicted by five parameters: CPP of the sentence and vowel production, the self-perceived severity subscale score of the K-VAPP, σCPP of the vowel production, and gender. The AUC of the novel index was 0.935 (95% confidence interval 0.891-0.965) and significantly higher than that of the CSID of vowel samples (AUC = 0.832). The cutoff score with the highest Youden J Index (0.7612) was >22.257617 (sensitivity = 82.12%, specificity = 94.00%). CONCLUSION: The current data showed the possibility that a novel index reflecting both acoustic and psychometric correlates of auditory-perceptual estimates for dysphonia severity could be suggested and possibly named as the "Acoustic Psychometric Severity Index of Dysphonia (APSID)." Further studies pertaining to the follow-up of various voice disorders are needed to extend its clinical usefulness.

Alternating Unilateral Versus Bilateral Injections of Botulinum Toxin for the Treatment of Adductor Spasmodic Dysphonia.

OBJECTIVE: This study aimed to compare the long-term efficacy, durability, and dose and interval stability between alternating unilateral and bilateral injections of botulinum neurotoxin type A for the treatment of adductor spasmodic dysphonia. STUDY DESIGN: Retrospective cohort study. SETTING: Academic tertiary medical center. METHODS: A total of 137 patients (105 alternating unilateral and 32 bilateral injections) who were administered ≥5 injections of botulinum neurotoxin type A were included in this study. The mean dosage change, dose adjustment ratio (number of dose increases/total number of injections), and stability of treatment responses were compared between the alternating unilateral and bilateral injection groups. RESULTS: Long-term changes in the mean dosages for alternating unilateral (mean ± SD, -0.010 ± 0.048 IU) and bilateral (-0.042 ± 0.142 IU) injections did not differ between groups (P = .225), suggesting that both methods follow a decreasing dosing trend over time. The dose adjustment ratio also did not differ between groups (P = .077), although a longer average treatment interval (P < .001) and duration of hoarse voice (P = .045) were found in the bilateral injection group. The proportion of stable patients who did not increase injection dose and had regular follow-up did not differ between the groups. CONCLUSION: Both alternating unilateral and bilateral injection methods showed a long-term decreasing dosing trend, with comparable levels of efficacy, durability, and stability for treating adductor spasmodic dysphonia. Our findings indicate that alternating unilateral injections can be routinely performed with fewer side effects, albeit at shorter treatment intervals, than bilateral injections.

Factors influencing long-term treatment response to botulinum toxin injection for spasmodic dysphonia.

OBJECTIVE: The purpose of this study was to evaluate the outcomes of long-term botulinum toxin type A (BoNTA) treatment for adductor spasmodic dysphonia (AdSD) and to determine the factors predictive of treatment response by investigating dose stability and average intervals. DESIGN: Retrospective cohort study. SETTING: Academic tertiary medical centre. EXPOSURES: A total of 470 patients with adductor spasmodic dysphonia, who received electromyography-guided BoNTA injections over 12 years, were retrospectively enrolled in this study. MAIN OUTCOMES AND MEASURES: The patients' demographic data, baseline voice dynamics and treatment profiles (dose, frequency and intervals) were evaluated. Factors correlating with the dose adjustment ratio (number of increasing dosing/total number of BoNTA toxin injections) and changes in intervals between injections were statistically analysed. RESULTS: A total of 122 patients, who received ≥ 4 injections and whose average treatment interval was < 240 days, were finally evaluated. Of them, 115 (94.3%) were female and seven (5.7%) were male, and the mean age at initial treatment was 34.89 ± 13.07 and 41.14 ± 12.71 years, respectively. On average, patients received 18.00 ± 13.33 injections (1.67 ± 0.60 U/injection) to alternating unilateral vocal folds. The treatment period was 65.07 ± 43.28 months and the mean interval between injections was 4.16 ± 1.28 months. The mean dose adjustment ratio among patients who received ≥ 4 injections was 0.15 ± 0.13, and dose changes occurred 4.36 times/patient. The patients' age and gender significantly affected the treatment response, where younger or female patients showed greater dosing variability and shorter intervals between injections. However, the baseline voice dynamics (voice handicap index, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximum phonation time and degree of voice breaks) did not predict the dose adjustment ratio or interval changes. In addition, patients with fluctuating doses showed lower age and higher VHI subscale scores, and patients with short-treatment interval (< 100 days) showed higher SDF0. CONCLUSIONS: Almost all patients received stable low doses of BoNTA over time, irrespective of the baseline results. Patients' age, gender and VHI scores were correlated with poor treatment responses, such as frequent dose changes and shorter intervals between injections.

Treatment Outcomes of Angiolytic Laser-Assisted Glottoplasty in Patients With Sulcus Vocalis.

OBJECTIVE: We have been performing glottoplasty using angiolytic laser, including pulsed dye laser (PDL) or potassium titanyl phosphate (KTP) laser, for the treatment of sulcus vocalis. In this study, we retrospectively reviewed the treatment results of sulcus vocalis patients who had undergone glottoplasty using angiolytic laser and evaluated the efficacy and safety of this surgical technique. METHODS: From January 2008 to April 2016, 79 patients with sulcus vocalis who underwent angiolytic LASER-assisted glottoplasty were enrolled in the study. RESULTS: Of the 79 patients who participated in this study, 55 were male, and 24 were female. PDL was used for glottoplasty in 68 patients, and KTP was used in the remaining 11 patients. Seventy-seven patients underwent surgery for bilateral vocal cord lesions, and only 2 patients underwent surgery for unilateral vocal cord lesion. After glottoplasty using angiolytic laser, most patients showed continuous improvement of the GRBAS (grade, roughness, breathiness, asthenia, strain) score and Voice Handicap Index score until 6 months after the operation. In addition, we observed improvement of objective voice indices such as noise to harmonic ratio, jitter, shimmer, and maximal phonation time postoperatively. CONCLUSIONS: Based on these results, we confirmed the efficacy and safety of glottoplasty using angiolytic laser in sulcus vocalis patients. Further studies are needed to confirm appropriate laser settings such as frequency of treatments and total energy delivered to the lesion. Also, multi-institutional studies are needed to confirm the efficacy and safety of the operation.

A Comparison of Voice Activity and Participation Profiles Among Etiological Groups.

OBJECTIVES: The purpose of this study was to determine whether patients with functional voice disorders show voice activity and participation profiles different from those of the organic and neurogenic groups. METHODS: The Korean Version of the Voice Activity and Participation Profile (K-VAPP) was administered to 200 participants (150 patients with functional, organic, and neurogenic voice disorders, 50 for each etiological group, 50 controls without vocal complaint). The K-VAPP subscale scores of the etiological groups were compared, controlling for age, professional use of voice, and severity of voice disorder measured by overall severity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). RESULTS: Results of a one-way analysis of variance indicated significant differences in the overall severity across groups (neurogenic > functional = organic > control). Among four groups, the organic group showed higher mean Z-scores of the K-VAPP than the control group, and the functional group showed higher mean Z-scores of the K-VAPP than the organic group. Compared with the neurogenic group, the functional group showed lower mean Z-scores for total score, Activity Limitation Score, SUB3, and SUB5. A comparison among three etiological groups showed that the functional group did not show higher scores than the organic group. On the contrary, the functional group showed a lower total score, Participation Restriction Score, and score for subsection 3 (effect on daily communication) than the neurogenic group. CONCLUSIONS: Psychometric assessment of voice disorders using the K-VAPP could provide clinicians with baseline information that is applicable to various voice disorders. Further studies pertaining to the follow-up of voice disorders with various etiologies are needed to extend its clinical usefulness.

Clinical Characteristics and Management of Saccular Cysts: A Single Institute Experience.

OBJECTIVES: A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology. METHODS: Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center. RESULTS: Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO2 laser. There was no recurrence after the initial surgical treatment. CONCLUSION: Saccular cysts can be managed endoscopically using CO2 laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.

Publisher Correction: Dose de-escalation to the normal larynx using conformal radiotherapy reduces toxicity while maintaining oncologic outcome for T1/T2 glottic cancer.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Angiolytic laser stripping versus CO2 laser microflap excision for vocal fold leukoplakia: Long-term disease control and voice outcomes.

BACKGROUND AND PURPOSE: Vocal fold leukoplakia, white plaque on the epithelium, has the potential for malignant transformation regardless of dysplasia grade. It is treated with different laser types (CO2 or angiolytic) and various techniques (vaporization, stripping, or excision); however, only a few studies exist regarding comparative laser surgery results. This study was conducted to investigate clinical outcomes of CO2 versus angiolytic laser microdissection with regard to long-term disease control and voice preservation in vocal fold leukoplakia. MATERIALS AND METHODS: Seventy patients with vocal fold leukoplakia treated by CO2 or angiolytic laser (pulsed dye laser or potassium titanyl phosphate) were identified retrospectively. Data regarding patient characteristics, treatment details, treatment outcomes including disease control (recurrence and progression) and the Voice Handicap Index, GRBAS scale, and acoustics were evaluated. The mean follow-up duration after initial treatment was 32 ± 26 months. RESULTS: The study group comprised 14 patients who underwent CO2 laser microflap excision and 56 who underwent angiolytic laser stripping. Of the patients treated with CO2 laser, 11 (79%) had no recurrence and three (21%) showed recurrent leukoplakia, of which one patient (7%) showed histologic grade progression. Of patients who underwent angiolytic laser stripping, 12 had disease recurrence (21%), among whom three (5%) showed disease progression. Laser surgery type, disease extent, and histologic grade showed no significant differences in recurrence or progression rates. The postoperative Voice Handicap Index significantly improved (P = .03) and the G score significantly decreased (P < .001) in the angiolytic laser treatment group. In contrast, the Voice Handicap Index increased postoperatively in the CO2 laser group (P = .046). CONCLUSIONS: The long-term recurrence or progression rates were not significantly different between angiolytic and CO2 laser treatment. The angiolytic laser stripping group showed better voice preservation compared with the CO2 laser group. Angiolytic laser stripping is suggested as an effective treatment option for vocal fold leukoplakia with comparable disease control and better voice preservation.

Dose de-escalation to the normal larynx using conformal radiotherapy reduces toxicity while maintaining oncologic outcome for T1/T2 glottic cancer.

We evaluated the efficacy of dose de-escalation to the normal larynx using conformal radiotherapy (CRT) for T1/T2 glottic cancer. For conventional RT (2DRT, n = 38), the laryngeal box received a median equivalent dose in 2 Gy fractions (EQD2) of 66 Gy. For CRT (n = 42; 3D-CRT, 20; intensity-modulated RT, 22), clinical target volume (CTV)1 (gross tumor with a 3-mm margin) and CTV2 (laryngeal box) received median EQD2s of 66.6 Gy and 52.2 Gy, respectively. With a 71-month median follow-up, five-year local control and overall survival rates for 2DRT vs. CRT were 88.1% vs. 95.1% (p = 0.405) and 94.7% vs. 90.7% (p = 0.102), respectively. Grade 2 and 3 pharyngitis rates were 52.6% and 5.3% for 2DRT vs. 35.7% and 2.4% for CRT (p = 0.121). Grade 2 and 3 dermatitis rates were 42.1% and 2.6% for 2DRT vs. 35.7% and 0% for CRT (p = 0.013). The maximum phonation time increased from 12.1 ± 7.1 to 14.0 ± 6.6 seconds after 2DRT (p = 0.375) and from 12.0 ± 5.5 to 13.8 ± 10.1 seconds after CRT (p = 0.313). Fundamental frequency decreased from 150.6 ± 40.3 to 121.9 ± 30.2 Hz after 2DRT (p = 0.039) and from 138.5 ± 31.9 to 126.1 ± 23.7 Hz after CRT (p = 0.058). CRT can effectively de-escalate the normal larynx dose while maintaining oncologic outcome and voice quality.

Secondary submucosal vocal cyst following pulsed dye laser application for sulcus vocalis.

CONCLUSION: Submucosal vocal cyst can occur as a distinct long-term sequelae following pulsed dye laser (PDL) application for sulcus vocalis. It is recommended that the cyst lesion should be surgically removed for treatment. Optimal and precise irradiation of PDL is considered important to avoid the development of a such complication. OBJECTIVE: After several years of clinical practice and an extended period of follow-up of the patients who received PDL application in treating sulcus vocalis, the authors have encountered several cases of secondary submucosal vocal cyst development. Therefore, this study aims to investigate this late complication following PDL laryngeal surgery. METHODS: Patients who developed secondary submucosal vocal cyst after last PDL laryngeal surgery between March 2008 and January 2016 were analyzed after retrospectively reviewing clinical and operative data. RESULTS: There were a total 11 patients who had been identified as presenting secondary submucosal vocal cyst among 186 patients who underwent PDL laryngeal surgery (5.9% incidence). All five patients who received surgery showed complete resolution and were free of symptoms. The remaining six patients were closely observed with conservative measures, with only one patient who showed resolution of the cyst.

Treatment of Hemorrhagic Vocal Polyps by Pulsed Dye Laser-Assisted Laryngomicrosurgery.

OBJECTIVE: Conventional surgical techniques of laryngomicrosurgery (LMS) on hemorrhagic vocal polyps are often difficult due to obscuration of the surgical field by inadvertent bleeding from the lesion, and there are often significant amounts of mucosal epithelium loss. Here, we introduce our surgical technique using pulsed dye laser (PDL), which can effectively resect the polyp with vocal fold mucosa preservation. METHODS: Patients who were diagnosed with hemorrhagic vocal polyp and who were surgically managed using PDL from March 2013 to October 2014 were retrospectively reviewed. Preoperative and postoperative clinical outcomes and surgical findings were evaluated. RESULTS: A total of 39 patients were treated with PDL-assisted enucleation LMS. The average age was 43.7 years (range 20-73), and there were 20 males and 19 females (17 professional voice users). In all cases, the hemorrhagic polyp was successfully enucleated after application of PDL, thereby preserving the overlying epithelium. Postoperative voice outcomes were favorable with clear preservation of the vocal fold mucosal wave. CONCLUSION: PDL-assisted enucleation LMS for the treatment of hemorrhagic vocal polyps can be a safe and effective surgical technique. It can be considered a promising treatment option for hemorrhagic vocal polyps.

A low grade fibromyxoid sarcoma originating from the masseter muscle: a case report.

INTRODUCTION: Low grade fibromyxoid sarcoma is a distinctive variant of fibrosarcoma. We recently experienced a rare case of low grade fibromyxoid sarcoma arising in the masseter muscle. CASE PRESENTATION: A 63-year-old Korean woman with a large growing mass in her right parotid gland area for 1 year visited our clinic. Complete removal of the tumor was achieved by parotidectomy with facial nerve preservation. The tumor measured over 4cm with pathologic findings compatible with low grade fibromyxoid sarcoma. CONCLUSIONS: Low grade fibromyxoid sarcoma is an extremely rare tumor, and report of the present case is noteworthy since it represents a rare localization of low grade fibromyxoid sarcoma in the head and neck. Close follow up on a long-term basis is considered necessary because of its high potential to metastasize.

Phonatory outcome of 585 nm/pulsed-dye laser in the management of glottic leukoplakia.

OBJECTIVE: Vocal cord mucosectomy using pulsed-dye laser was assessed for its ability to completely remove lesions without deterioration of vocal quality in cases of vocal cord leukoplakia. To confirm the validity of a pulsed-dye laser, we retrospectively analyzed the treatment outcomes of patients who received surgery preceded by pulsed-dye laser and compared these with the outcomes of patients who received vocal cord mucosectomy using CO2 laser. METHODS: Between February 2007 and June 2012, 36 patients were enrolled. Seventeen patients received vocal cord treatment with a CO2 laser and 19 patients received operation with a pulsed-dye laser. To evaluate voice status, acoustic wave form analysis and electroglottography were done, and voice handicap index was measured before and after the operation. RESULTS: The entire lesion was removed in all patients. Compared to preoperative vocal parameters, the postoperative values for jitter were only improved in the pulsed-dye laser group. On stroboscopic findings, a diminution or lack of mucosal wave was observed in more CO2 laser cases than pulsed-dye laser cases. Significant improvement in voice handicap index results was only observed in the pulsed-dye laser group. CONCLUSION: Although long-term results with more patients are required to establish the validity of pulsed-dye laser, this study confirmed the merits of pulsed-dye laser for the en-bloc removal of vocal cord leukoplakia and improved voice outcome.

Outcome with immediate direct anastomosis of recurrent laryngeal nerves injured during thyroidectomy.

OBJECTIVES/HYPOTHESIS: Management of unrecognized recurrent laryngeal nerve injury typically entails delayed phonosurgical intervention and laryngeal reinnervation, but in cases of recognized injury, nerve anastomosis has been considered standard management. However, the well-organized outcome analysis of nerve anastomosis has been insufficient. We performed immediate direct anastomosis of recurrent laryngeal nerves injured during surgery for thyroid cancer, and subsequent patient outcomes were analyzed. STUDY DESIGN: A total 14 patients sustaining recurrent laryngeal nerve injury during thyroidectomy were recruited for the study. Patients undergoing immediate direct reparative anastomosis of the injured nerves constituted the test group, whereas the controls of group 2 (n = 4) did not. METHODS: At follow-up, all patients submitted to rigid laryngoscopy at 3, 6, and 12 months postoperatively. Subjective and objective outcomes of the two groups were then compared. RESULTS: At 12 months postoperatively, group 1 showed greater improvement in maximum phonation time, glottic gap scores, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, aspiration scoring, and Voice Handicap Index than controls of group 2. Moreover, group 1 showed an improvement in all five categories at 12 months postoperatively, compared with status at 3 months. None of the patients in group 1 showed laryngoscopic evidence of vocal cord atrophy. CONCLUSION: In this study, patients undergoing immediate direct recurrent laryngeal nerve anastomosis demonstrated better phonation and perceptually rated voice quality than those who did not undergo repair. LEVEL OF EVIDENCE: 3b.

Carcinoma ex pleomorphic adenoma in the oral cavity: a huge oral cavity mass with neck metastasis.

Carcinoma ex pleomorphic adenoma (CEPA) is a rare, aggressive, poorly understood malignancy. In CEPA, an epithelial malignancy develops in association with a primary or recurrent benign pleomorphic adenoma. Carcinoma ex pleomorphic adenoma is very difficult to identify before surgery because the clinical presentation of many cases is similar to that of pleomorphic adenomas. The risk for malignancy increases with the duration of a mixed tumor. Treatment of CEPA must be individualized on the basis of the tumor location, involvement of adjacent structures, histologic subtype, and grade. The authors recently experienced a case of CEPA arising in the oral cavity with neck metastasis. The patient was a 70-year-old man presenting a huge mass that was present for 20 years and that slowly grew on the left side of the neck. We treated it with a total excision with wide margins and neck dissection. There was no recurrence during the follow-up period of 5 years up until now. We present a case of an unusually huge CEPA in the oral cavity.

Clinical characteristics of vocal polyps with underlying sulcus vocalis.

OBJECTIVE: This study aims to find a correlation between vocal fold polyps and sulcus vocalis and to investigate the character of such vocal fold polyps associated with sulcus vocalis. STUDY DESIGN: Retrospective clinical research. METHODS: A retrospective review of 280 patients who have been admitted and operated under general anesthesia for vocal fold polyps at a tertiary care medical center from March 2009 to July 2012 was performed. RESULTS: The patients were classified into two groups. Group A (18 patients) was defined as patients who have been diagnosed with vocal polyps coexisting with sulcus vocalis. Group B (262 patients) was designated to the rest of the patients who have been solely diagnosed with vocal fold polyps. The prevalence of an underlying sulcus vocalis associated with vocal polyps in the studied population overall was 6.4% (18/280). Considering the recurrence rate of vocal fold polyps in each group, it was 16.7% (three patients) in group A and 3.1% (eight patients) in group B. In general, there was an improvement in the voice quality after the operation in both groups. The degree of improvement was less substantial in group A rather than group B. CONCLUSION: When dealing with patients who have been diagnosed as vocal fold polyps, the possibility of coexisting sulcus vocalis should always be considered, and if diagnosed simultaneously, management of vocal polyps and sulcus vocalis must be sought for a better voice outcome and to reduce the chance of recurrence of vocal polyps.

Use of pulsed dye laser in the treatment of sulcus vocalis.

OBJECTIVE: The pulsed dye laser (PDL) has been shown to be effective in the treatment of hypertrophic scars and keloids in dermatology. On the basis of histopathologic similarities between sulcus vocalis and scar tissue and numerous reports on the treatment of laryngeal lesions, especially scar tissue, with PDL, we evaluated the efficacy of treating sulcus vocalis with PDL. We named this surgical procedure PDL glottoplasty. STUDY DESIGN: Case series with planned data collection. SETTING: A university-based, tertiary care medical center. SUBJECTS AND METHODS: This study was conducted on 25 patients diagnosed with sulcus vocalis by videostroboscopy at the Gangnam Severance Hospital Otorhinolaryngology Department between August 2006 and February 2012. Energy delivery was fixed at 0.75 Joules (J) per pulse, and each vocal fold was administered 60 to 110 pulses (average 72.5 pulses) during each procedure. Aerodynamic, stroboscopic, and acoustic voice analyses were performed pre- and postoperatively. RESULTS: Although assessment was necessarily subjective, our study indicated that vocal folds showed decreased stiffness and improved mucosal wave properties after treatment, resulting in improved vibration and dysphonia. In the objective assessments, most patients who underwent PDL glottoplasty showed improvement in several postoperative voice analysis indices. The differences between preoperative and some postoperative voice parameter indices were statistically significant. CONCLUSION: We found PDL glottoplasty to be beneficial in the treatment of sulcus vocalis. Objective measurements of voice quality and normalization of vocal fold vibration improved after PDL treatment in most cases. Our results warrant further studies with larger numbers of participants and longer follow-up periods.