Abstract
Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold’s mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1–105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser.
Highlights
Recurrent respiratory papillomatosis (RRP) is a rare disease occurring in both children and adults
The hypothesis of our study based on our clinical observations is that additional use of cidofovir leads to significantly improved phonation in this group of patients
The standard procedure comprised laser ablation followed by intralesional cidofovir injection
Summary
Recurrent respiratory papillomatosis (RRP) is a rare disease occurring in both children and adults. University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznań, Poland. Student Research Group at the Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznań, Poland the larynx and trachea but it can spread to any part of the respiratory tract. The etiological agent of RRP is human papilloma virus types 6 and/or 11, and rarely 16 or 18. The main symptoms of this disease are hoarseness, dysphonia, stridor, and in some cases respiratory distress. RRP is a mild but recurring disorder; it rarely becomes malignant. The main problems in vocal fold RRP localization are the treatment sequelae, calling into question how to preserve good vocal quality after multiple surgical procedures [3]
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