Voice Quality Outcomes After Transoral CO2 Laser Cordectomy: A Longitudinal Prospective Study

Jerome R Lechien; Lise Crevier-Buchman; Marta P Circiu; Erwan De Mones; Grégoire Vialatte de Pemille; Aude Julien-Laferriere; Sven Saussez; Robin Baudouin; Marc Remacle; Stephane Hans

doi:10.1177/01945998221114762

Voice Quality Outcomes After Transoral CO₂ Laser Cordectomy: A Longitudinal Prospective Study

Otolaryngol Head Neck Surg. 2023 Mar;168(3):422-428. doi: 10.1177/01945998221114762. Epub 2023 Jan 29.

Authors

Jerome R Lechien^{1

2

3

4}, Lise Crevier-Buchman^{3

5}, Marta P Circiu³, Erwan De Mones⁶, Grégoire Vialatte de Pemille³, Aude Julien-Laferriere³, Sven Saussez^{2

4}, Robin Baudouin³, Marc Remacle⁷, Stephane Hans^{3

5}

Affiliations

¹ Department of Otolaryngology, Elsan Hospital, Paris, France.
² Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium.
³ Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
⁴ Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.
⁵ Phonetics and Phonology Lab, CNRS UMR7018, Sorbonne University, Paris, France.
⁶ Department of Otolaryngology-Head and Neck Surgery, Pellegrin Hospital, University Hospital, CHU Bordeaux, Bordeaux, France.
⁷ Department of Otolaryngology-Head and Neck Surgery, Eich Luxembourg Hospital, Luxembourg, Luxembourg.

PMID: 35998041
DOI: 10.1177/01945998221114762

Abstract

Objective: To evaluate the evolution of voice quality in patients after type I-VI transoral CO₂ laser cordectomy (TLC) by using validated voice outcome measures over a 12-month period.

Study design: Prospective uncontrolled study.

Setting: Monocenter study.

Methods: Patients with laryngeal carcinoma who were eligible for type I-IV TLC were prospectively recruited from a tertiary medical center. The following outcomes were assessed throughout the 12-month posttreatment period: Voice Handicap Index (VHI), GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain), maximal phonation time, fundamental frequency (F0), F0 standard deviation, percentage jitter, percentage shimmer, noise-to-harmonic ratio, and speech fluency. Analyses were performed considering 2 groups of cordectomies: type I-III vs IV-VI.

Results: A total of 131 patients completed the evaluations, totaling 76 type I-III and 55 type IV-VI cordectomies. In type IV-VI, breathiness and maximal phonation time significantly worsened from pretreatment to 1 month posttreatment (P < .05). In the type I-III cordectomy group, VHI, shimmer, roughness, breathiness, and strain significantly improved from pretreatment to 3 months posttreatment, while VHI, F0 standard deviation, shimmer, jitter, grade of dysphonia, roughness, breathiness, and strain improved from baseline to 6 months. Assessments at 12 months posttreatment revealed significant improvements for VHI, shimmer, jitter, noise-to-harmonic ratio, grade of dysphonia, roughness, breathiness, and strain. In the type IV-VI group, VHI significantly improved from baseline to 3, 6, and 12 months posttreatment. Strain improved at 6 and 12 months while roughness improved from baseline to 12 months. Maximal phonation time significantly worsened over the 12-month evaluation period.

Conclusion: The effect of TLC on voice quality depends on its type. VHI was identified as the most indicative tool of voice changes irrespective of TLC type.

Keywords: CO2; cancer; cordectomy; head neck; laryngeal; laryngology; larynx; laser; otolaryngology; voice.

MeSH terms

Carbon Dioxide
Dysphonia* / etiology
Humans
Lasers, Gas* / therapeutic use
Prospective Studies
Treatment Outcome
Voice Quality

Substances

Carbon Dioxide