Original Article |

Office-Based Potassium Titanyl Phosphate Laser–Assisted Endoscopic Vocal Polypectomy

Chi-Te Wang, MD, MPH; Tsung-Wei Huang, MD, PhD; Li-Jen Liao, MD, MPH; Wu-Chia Lo, MD; Mei-Shu Lai, MD, PhD; Po-Wen Cheng, MD, PhD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):610-616. doi:10.1001/jamaoto.2013.3052.
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Importance Vocal polyps are common exophytic laryngeal lesions that usually necessitate microscopic laryngeal surgery under general anesthesia. Office-based indirect laryngoscopic procedures provide an alternative management option and can be performed comfortably under flexible endoscopic guidance. Combining angiolytic potassium titanyl phosphate (KTP) laser treatment and flexible endoscopic polypectomy should alleviate the risks of surgery under general anesthesia and expedite lesion regression.

Objectives To combine angiolytic KTP laser treatment and endoscopic polyp removal and to evaluate the clinical applicability, treatment outcomes, and adverse effects of office-based KTP laser–assisted vocal polypectomy.

Design Case series of KTP laser treatment (n = 16) and KTP laser–assisted polypectomy (n = 20). Patients underwent pretreatment and 2- and 6-week posttreatment evaluation with videolaryngostroboscopy (VLS), maximal phonation time, and a 10-item voice handicap index. Perceptual (GRB [grade, roughness, breathiness] scale) and acoustic analyses were performed before and 6 weeks after treatment.

Setting Tertiary teaching hospital.

Participants Thirty-six outpatients with unilateral hemorrhagic vocal polyps.

Interventions Under local anesthesia, the KTP laser fiber was passed through the working channel of the flexible laryngoscope to photocoagulate the microvasculature of the polyp in all patients. Removal of coagulated vocal polyp using a flexible, endoscopic, blunt-ended grasping forceps immediately after KTP laser application was performed in the polypectomy group.

Main Outcomes and Measures Results of VLS, maximal phonation time, 10-item voice handicap index, and perceptual and acoustic analyses.

Results Six weeks after KTP laser treatment with and without polypectomy, 19 and 12 patients, respectively, experienced complete recovery and much improvement of mucosal wave. Maximal phonation time and the voice handicap index improved significantly 2 weeks after KTP laser with polypectomy (P < .01), whereas significant improvements were noted 6 weeks postoperatively in both treatment groups (P < .05). Acoustic and perceptual analyses also revealed significant improvements in both study groups (P < .05). During follow-up, we did not notice significant adverse effects.

Conclusions and Relevance Potassium titanyl phosphate laser–assisted vocal polypectomy is a safe, practical, and effective alternative option to treat hemorrhagic vocal polyps in the outpatient department, offering comparable but earlier therapeutic effects than KTP laser alone.

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Figure 1. Potassium titanyl phosphate (KTP) laser–assisted vocal polypectomy in a 48-year-old woman. A, Darkening of the hemorrhagic polyp during KTP laser photocoagulation. B, Blunt-ended endoscopic grasping forceps applied for polypectomy through the operating channel of a flexible endoscope. C, Limited oozing from the wound occurs after removal of the vocal polyp.

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Figure 2. Vocal fold appearance in a 42-year-old woman. A, Preoperative view shows a left-sided vocal polyp and varices (arrow). B, Two weeks after potassium titanyl phosphate laser–assisted vocal polypectomy, a straight vocal fold edge and regressed varices are seen.

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Figure 3. Comparison of objective and subjective pretreatment measurements with 2- and 6-week posttreatment measurements in the groups undergoing potassium titanyl phosphate (KTP) laser treatment alone and with vocal polypectomy. A, Maximal phonation time (MPT). B, Ten-item voice handicap index (VHI-10). Comparisons used the paired t test. * P < .01; † P = .02.




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