Surgical and Voice Outcomes of Office-Based Laser Therapy for Benign Lesions of the Vocal Folds: A Systematic Review of the Literature.

OBJECTIVE

To investigate the surgical and voice quality outcomes of office-based laser therapy for benign vocal fold lesions (BVFL).

METHODS

Two independent investigators searched PubMed, Google Scholar, and Cochrane databases for studies reporting surgical or voice quality outcomes of patients treated with office-based surgery for BVFL, including cysts, pseudocysts, polyps, nodules, granulomas, scars, sulci, and varices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Primary outcomes included lesion regression, complications, number of interventions, patient tolerance, and voice quality assessments. The bias analysis was carried out with the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

Forty-one studies met the inclusion criteria, accounting for 1936 patients with BVFL. Potassium-Titanyl-Phosphate (KTP), pulsed dye laser (PDL), and blue laser were the most frequently used lasers. Office-based laser therapy demonstrated a cumulative complication rate of 2.4%, with vocal fold hyperemia and edema being the most common complications. Complete lesion resolution rates ranged from 70% to 100% in most studies, while partial regression occurred in 27% to 75% of cases. Subjective [Voice Handicap Index (VHI-10), Grade of dysphonia, Roughness, Breathiness, Asthenia, Strain (GRBAS)] and objective voice parameters [percent jitter, percent shimmer, noise-to-harmonic ratio (NHR), and maximum phonation time (MPT)] commonly demonstrated pretreatment to post treatment significant improvements. Multidimensional voice quality assessment protocols were used in a small number of studies. Substantial heterogeneity existed across studies regarding inclusion criteria, surgical approaches, and voice quality outcome measurements. MINORS scores demonstrated low-to-moderate methodological quality of all studies.

CONCLUSION

Office-based laser surgery is a safe and effective treatment for BVFL leading to complete or partial lesion regression in most cases. Future studies need to consider multidimensional voice quality assessment protocols to evaluate longitudinal voice quality outcomes.