The Journal of laryngology and otology · 2011
Evaluation of voice and quality of life after transoral endoscopic laser resection of early glottic carcinoma.
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Bajaj Y, Uppal S, Sharma R K, Grace A R H, Howard D M, Nicolaides A R, Coatesworth A P
Аннотация
OBJECTIVE: This study aimed to evaluate voice and quality of life after transoral laser resection of early glottic carcinoma.
METHODS: We studied 19 patients undergoing transoral laser resection of tumour stage (T) one or T2 glottic carcinoma. Laryngeal function was evaluated by video-stroboscopy, vocal function by the Voice Symptom Scale, the grade-roughness-breathiness-asthenia-strain scale and objective phoniatric assessment, and quality of life by the University of Washington Quality of Life questionnaire.
RESULTS: Patients' glottic carcinoma tumour-node-metastasis (TNM) staging was T1 N0 M0 in 14 patients and T2 N0 M0 in five. Overall voice grade, roughness and breathiness were mild to moderate in 84 per cent; asthenia and voice strain were more uniformly distributed, with 15 per cent of patients having normal voice quality. Eight patients developed a glottic web post-operatively; anterior commissure web was significantly associated with worse voice grade (p = 0.05). Seven patients (47 per cent) had a 'mucosal wave' on the operated vocal fold; this was significantly associated with less strain on phonation (p = 0.05). Voice Symptom Scale score was low overall (15 patients (78.9 per cent) scored less than 30). The fundamental frequency and frequency irregularity were normal in nine patients (47.3 per cent); the closed quotient was normal in six (31.5 per cent). The averaged quality of life score was ≥ 90 in 14 patients (73.7 per cent); 18 (94.7 per cent) felt their health-related quality of life was either the same or better post-operatively; and overall quality of life was positive in all.
CONCLUSION: Transoral laser resection of T1 and T2 glottic carcinoma enables adequate tumour tissue excision with preservation of acceptable vocal function. Most patients' post-operative quality of life is very good. Anterior commissure web formation is associated with poorer vocal function.
METHODS: We studied 19 patients undergoing transoral laser resection of tumour stage (T) one or T2 glottic carcinoma. Laryngeal function was evaluated by video-stroboscopy, vocal function by the Voice Symptom Scale, the grade-roughness-breathiness-asthenia-strain scale and objective phoniatric assessment, and quality of life by the University of Washington Quality of Life questionnaire.
RESULTS: Patients' glottic carcinoma tumour-node-metastasis (TNM) staging was T1 N0 M0 in 14 patients and T2 N0 M0 in five. Overall voice grade, roughness and breathiness were mild to moderate in 84 per cent; asthenia and voice strain were more uniformly distributed, with 15 per cent of patients having normal voice quality. Eight patients developed a glottic web post-operatively; anterior commissure web was significantly associated with worse voice grade (p = 0.05). Seven patients (47 per cent) had a 'mucosal wave' on the operated vocal fold; this was significantly associated with less strain on phonation (p = 0.05). Voice Symptom Scale score was low overall (15 patients (78.9 per cent) scored less than 30). The fundamental frequency and frequency irregularity were normal in nine patients (47.3 per cent); the closed quotient was normal in six (31.5 per cent). The averaged quality of life score was ≥ 90 in 14 patients (73.7 per cent); 18 (94.7 per cent) felt their health-related quality of life was either the same or better post-operatively; and overall quality of life was positive in all.
CONCLUSION: Transoral laser resection of T1 and T2 glottic carcinoma enables adequate tumour tissue excision with preservation of acceptable vocal function. Most patients' post-operative quality of life is very good. Anterior commissure web formation is associated with poorer vocal function.