In-Office KTP Laser Surgery for Benign Vocal Fold Lesions in East Asian Patients: Voice Outcomes and Procedural Tolerance.

OBJECTIVES/HYPOTHESIS: To determine whether in-office potassium-titanyl-phosphate (KTP) laser surgery provides significant voice improvement and acceptable tolerance in East Asian patients with benign vocal-fold lesions.

STUDY

DESIGN

Retrospective single-center cohort (Level IV).

METHODS

Eighty-two consecutive adults (mean ± SD = 43.7 ± 13.7 years) underwent in-office KTP laser surgery under topical anesthesia between March 2024 and February 2025. Preoperative/postoperative assessments included the Voice Handicap Index (VHI), jitter, shimmer, soft-phonation index (SPI), noise-to-harmonics ratio (NHR), and videostroboscopy (glottic closure, mucosal wave, each graded on a 0-3 ordinal scale) by a single board-certified otolaryngologist, and tolerance metrics-nasal pain, throat pain, and gag-reflex intensity measured on a 0-10 visual analogue scale (VAS), and willingness-to-repeat/-recommend measured on a 0-10 numeric rating scale (NRS). Wilcoxon signed-rank tests and Spearman correlations were applied.

RESULTS

VHI improved by -33 points (95% CI -40.6 to -25.4; P < 0.001). Jitter, shimmer, and SPI fell by 36%, 41%, and 29%, respectively (P ≤ 0.004); NHR showed no significant change. Videostroboscopy confirmed better glottic closure (+1.33) and mucosal wave (+0.47; P < 0.001). Mean nasal pain 2.95 ± 1.50, throat pain 2.14 ± 1.67, and gag reflex 2.67 ± 1.80 were modest; willingness-to-repeat and-recommend were 8.16 ± 2.27 and 7.26 ± 1.76. Nasal pain (ρ = -0.50) and gag reflex (ρ = -0.75) inversely correlated with willingness scores (P < 0.001); discomfort did not correlate with voice gains.

CONCLUSION

In-office KTP laser surgery yields robust, clinically meaningful voice improvement in East Asian patients while maintaining good patient acceptance. Optimizing topical anesthesia-particularly for patients with narrow nasal passages or septal spurs-may further enhance tolerance without compromising efficacy.

LEVEL OF EVIDENCE: Level IV.