European Laryngological Society Research Articles

Crossing Borders: 95. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie vom 8. bis 11. Mai 2024 in Essen.

Dear colleagues,Dear readers,We are constantly developing innovative solutions and treatment concepts for our patients in our discipline. In this context, interdisciplinary collaboration is essential. The conference motto "Crossing Borders: interdisciplinary, international, interactive" of the 95th Annual Meeting of the German Society of Otorhinolaryngology, Head and Neck Surgery emphasizes the relevance of interdisciplinary cooperation and global exchange. This year, joint meetings with the European Laryngological Society (ELS) and the Rhinoplasty Society of Europe (RSE) will take place for the first time. The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) and the Confederation of European Otorhinolaryngology - Head and Neck Surgery (CEORL-HNS) are also involved in the scientific program. The interdisciplinary presentations offer insights into the most recent developments in the fields of head and neck oncology, skull base and orbital surgery, among others. They are a great opportunity to expand your own knowledge and exchange the latest research findings.

Peroperační využití potencované kontaktní endoskopie k hodnocení maligního potenciálu slizničních lézí hrtanu, validace ELS klasifikace

Summary Introduction: Enhanced contact endoscopy (ECE) – combination of contact endoscopy and NBI (narrow-band imaging) or IMAGE1 S, is a noninvasive optical technique used for assessment of superfi cial vascular changes of mucosal lesions in high magnifi cation. Aim: The aim of our study was to evaluate the dia gnostic value of ECE in an intraoperative settlement and validation of the ELS classifi cation. Methods: Patients with laryngeal lesions underwent direct laryngoscopy with a structured assessment of the lesion using white light, NBI and ECE. Lesions were classified according to the European Laryngological Society Classifi cation that divides the vascular pattern changes into longitudinal (unsuspicious) and perpendicular (suspicious). Evaluation was correlated with histopathology. Results: 60 patients with 76 lesions were enrolled. Sensitivity, specifi city, positive predictive value (PPV), negative predictive value (NPV) and accuracy for NBI assessment reached 71.4%, 100%, 100%, 53.8% and 78.6%, resp.,  index of 0.556. Sensitivity, specifi city, PPV, NPV and accuracy for ECE reached 86.4%, 89.5%, 95.0%, 73.9% and 87.3%,  index of 0.716. Additional 20% (9/ 45) of the leukoplakias could be assessed with ECE compared to NBI. Conclusions: Our data support the assumption that ECE is a useful tool for pre-histological examination of mucosal lesions, however it cannot fully replace bio psy sampling. ECE shows higher accuracy in detecting malignant lesions compared to NBI and can be especially helpful in the assessment of vocal fold leukoplakia. Key words enhanced contact endoscopy – narrow-band imaging – laryngeal mucosal lesions – squamous cell carcinoma – leukoplakia

Validation of Ni\'s Grading and European Laryngological Society Grading for Laryngeal Lesions: A Prospective Cross-sectional Study

Validation of Ni\'s Grading and European Laryngological Society Grading for Laryngeal Lesions: A Prospective Cross-sectional Study

Clinical significance of type IV vascularization of laryngeal lesions according to the Ni classification

BackgroundScattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to “Ni classification” and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed.MethodsThe study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically.ResultsA total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%.ConclusionLaryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.

Twenty questions from the surgeon to the radiologist to better plan an open partial horizontal laryngectomy.

Open partial horizontal laryngectomies (OPHLs) represent a valuable therapeutic option for tumors of the intermediate T-category and, in selected cases, for locally advanced tumors with low-volume extra-laryngeal extension. The eligibility of patients treated with this type of surgery has increased with the introduction of the modular approach to OPHL planning. This strategy follows the introduction of the classification proposed by the European Laryngological Society, based on the extent of horizontal resection. Optimization of the selection is the result of a meticulous work-up process involving close cooperation between experienced surgeons and radiologists, followed by final quality control by pathologists. Computed tomography and magnetic resonance imaging are study methods whose pearls and pitfalls are well known, especially when performed at a high level of expertise. In this paper, based on the experience of two high-volume centers, a checklist of 20 questions addressed by the surgeon to the radiologist before planning an OPHL was proposed. Considerations regarding case selection are reported for each of the questioned parameters. A very simple question-and-answer process is easy to understand and mainly addressed by less experienced colleagues who wish to increase their knowledge and skills in performing this type of surgery.

Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians.

To update the European guidelines for the assessment of voice quality (VQ) in clinical practice. Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases. The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.

Partial Laryngectomy for pT4a Laryngeal Cancer: Outcomes and Limits in Selected Cases.

A large multi-institutional case series of laryngeal cancer (LC) T4a was carried out, including 134 cases treated with open partial horizontal laryngectomies (OPHL) +/- post-operative radiation therapy (PORT). The goal was to understand better whether OPHL can be included among the viable options in selected pT4a LC patients who refuse a standard approach, represented by total laryngectomy (TL) + PORT. All 134 patients underwent OPHL type I (supraglottic), II (supracricoid), or III (supratracheal), according to the European Laryngological Society Classification. Comparing clinical and pathological stages showed pT up-staging in 105 cases (78.4%) and pN up-staging in 19 patients (11.4%). Five-year data on overall survival, disease-specific survival, disease-free survival, freedom from laryngectomy, and laryngo-esophageal dysfunction-free survival (rate of patients surviving without a local recurrence or requiring total laryngectomy and without a feeding tube or a tracheostomy) were, respectively, 82.1%, 89.8%, 75.7%, 89.7%, and 78.3%. Overall, complications were observed in 22 cases (16.4%). Sequelae were observed in 28 patients (20.9%). No patients died during the postoperative period. This large series highlights the good onco-functional results of low-volume pT4a laryngeal tumors, with minimal or absent cartilage destruction, treated with OPHLs. The level of standardization of the indication for OPHL should allow consideration of OPHL as a valid therapeutic option in cases where the patient refuses total laryngectomy or non-surgical protocols with concomitant chemo-radiotherapy.

Editorial introductions.

Current Opinion in Otolaryngology & Head and Neck Surgery was launched in 1993. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of otolaryngology and head and neck surgery are divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITOR Cesare PiazzaCesare Piazza, MD, born in Cremona in 1971, has been Full Professor and Chief of the Department of Otorhinolaryngology – Head and Neck Surgery of the University of Brescia, Italy since September 2020. He received his MD degree at the University of Pavia, Italy, in 1996 and completed his residency program in otorhinolaryngology – Head and Neck Surgery in Brescia in 2001. He became Assistant Professor in 2007 and Associate Professor, Chief of the Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery of the National Cancer Institute, University of Milan, Italy, in 2017. His clinical and research activities are focused on head and neck oncology, with special emphasis to laryngo-hypopharyngeal, tracheal, oral, thyroid, parotid, sarcoma, laser, and reconstructive microsurgery. Dr Piazza is an active member of the European Laryngological Society since 2000, part of its Scientific Council since September 2010, and President since May 2021. He authored or co-authored 207 papers in peer-reviewed journals as well as 76 book chapters. He delivered 864 proffered papers and invited lectures in national and international Congresses and Courses. He has served as Section Editor of Current Opinion in Otolaryngology & Head and Neck Surgery for the Head and Neck Oncology issue since 2010 and has been a member of the journal's Editorial Board since 2013. He has been a member of the Editorial Board of Frontiers in Oncology since 2016 and Acta Otorhinolaryngologica Italica and Frontiers in Otolaryngology – Head and Neck Surgery since 2017. His surgical activity has been always mainly devoted to head and neck cancer treatment, with more than 6,000 surgical procedures performed in this field (of whom nearly 1200 were free flaps). Alberto PadernoDr Alberto Paderno, MD, born in Brescia in 1987, has been a Staff Member in the Department of Otorhinolaryngology – Head and Neck Surgery at the University of Brescia, Italy, since November 2018. He received his MD degree at the University of Brescia, Italy in 2012 and completed his residency programme in otorhinolaryngology – head and neck surgery in Brescia in 2018. He is currently a PhD candidate in the field of artificial intelligence in medicine. His clinical and research activities focus on head and neck oncology, with particular emphasis on laryngeal and hypopharyngeal cancer, oral malignant and potentially malignant disease, and transoral laser microsurgery. He is involved in various international studies in fields ranging from translational research, biomarkers, oncology, head and neck surgery, and artificial intelligence. He authored or co-authored 78 papers in peer-reviewed journals as well as five book chapters. He has served as Section Editor of Current Opinion in Otolaryngology & Head and Neck Surgery for the Head and Neck Oncology issue, since 2021. He is a member of the Editorial Board of Acta Otorhinolaryngologica Italica and topic Editor in Frontiers in Oncology, since 2020. His surgical activity is mainly focused on head and neck oncology and, in particular, transoral laser microsurgery.

Letter from Norway

Letter from Norway

Editorial introductions.

Editorial introductions.

Long-Term Oncologic Outcome of Transoral Laser Microsurgery for Early Glottic Cancer

Background and Objectives Traditionally, transoral laser microsurgery (TLM) is commonly used to treat early glottic cancer. However, the long-term oncologic results have not been thoroughly investigated. Therefore, this study aimed to analyze long-term oncologic outcomes of TLM for early glottic cancer.Subjects and Method We retrospectively studied 132 patients who underwent TLM for early glottis cancer from January 2001 to August 2020. We assessed overall and disease-free survival according to the T classification and types of cordectomy proposed by the European Laryngological Society in 2007.Results Of the 132 patients, 125 were male and 7 female. The mean age was 61.6±9.3 years. We found 5 (3.8%), 112 (84.8%), and 15 (11.3%) patients staged as CIS, T1, and T2, respectively. For the cordectomy types, there were 6 in type I, 22 in type II, 83 in type III, 6 in type IV, 13 in type V, and 2 in type VI. Ten-year overall and disease-free survival rates were 99.2% and 87.1%, respectively. Overall and disease-free survival curves were not different according to different T classification and cordectomy types.Conclusion TLM is an excellent treatment modality for the long-term oncologic control of early glottic cancer.

Informed consent for suspension microlaryngoscopy: what should we tell the patient? A consensus statement of the European Laryngological Society

IntroductionInformed consent for any surgical intervention is necessary, as only well-informed patients can actively participate in the decision-making process about their care, and better understand the likely or potential outcomes of their treatment. No consensus exists on informed consent for suspension microlaryngoscopy (SML).Materials and methodsInformed consent procedures in nine countries on five continents were studied.ResultsSeveral risks can be discerned: risks of SML as procedure, anesthesiologic risks of SML, specific risks of phonosurgery, risks of inadequate glottic exposure or unexpected findings, risks of not treating. SML has recognized potential complications, that can be divided in temporary (minor) complications, and lasting (major) complications.ConclusionSML is a safe procedure with low morbidity, and virtually no mortality. Eleven recommendations are provided.

Electromyography of the posterior cricoarytenoid muscles: a consensus guideline.

Since the introduction of transcutaneous-transcricoidal needle approaches, electromyography (EMG) of the posterior cricoarytenoid muscle (PCA) became easier to perform and teach. Among the Neurolaryngology working group of the European Laryngological Society, several centers have adopted PCA EMG as part of their routine EMG workup in vocal fold immobility collectively gathering long-term experience. The purpose is to give an update and an extension to already existing guidelines on laryngeal EMG with specific regard to PCA EMG. Consensus of all co-authors is based on continuous exchange of ideas and on joint laryngeal EMG workshop experiences over at least 7years. A Delphi method of consensus development was used, i.e., the manuscript was circulated among the co-authors until full agreement was achieved. Step-by-step instructions on how to perform and interpret PCA EMG are provided. Further research should include the establishment of normal values for PCA and thyroarytenoid muscle (TA) EMG as well as studies on the nature of some unusual activation pattern commonly seen in chronically lesioned PCA.

The surgical treatment of acquired subglottic stenosis in children with double-stage laryngotracheal reconstruction

ObjectivesThe aim of this study is to report our experience with double-stage laryngotracheal reconstruction with anterior or antero-posterior cartilage grafting in the management of acquired laryngotracheal stenosis in children. Patients were treated by the same surgeon at the UMC National Research Center for Maternal and Child Health of Astana (Kazakhstan), and Sfendiyarov Kazakh National Medical University, Almaty (Kazakhstan). MethodsFrom November 2011 to September 2019, 9 children underwent surgery for grade III and IV laryngotracheal stenosis according to the European Laryngological Society classification (mean age of 6 years, range of 2–12 years). ResultsSix patients underwent double-stage laryngotracheal reconstruction with anterior and posterior cartilage graft, and 3 patients underwent double-stage laryngotracheal reconstruction with single anterior cartilage graft. In all patients, a T-tube was used to stabilize the airway (mean time of 5.8 months, range of 5–9 months). One patient required additional dilation with bougies to obtain a viable laryngotracheal diameter. No postoperative complications were observed. One patient experienced recurrence of the stenosis 5 months after double-stage laryngotracheal reconstruction with double anterior and posterior cartilage grafts and is waiting for revision surgery. After a mean follow-up of 14 months (range of 4–36 months), 8 patients are tracheostomy-free, and all patients are feeding tube-free. ConclusionsDouble-stage laryngotracheal reconstruction with a single or double cartilage grafting represents a safe and effective option in the management of complete or severe laryngotracheal stenosis.

Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review.

Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.

Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience.

SUMMARYObjectiveThe COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation.MethodsA case series of patients who underwent tracheal resection and anastomosis (TRA) for post-COVID-19 LTS was collected from June 2020 to September 2021.ResultsAmong 14 patients included, 50% had diabetes and 64.3% were obese. During intensive care unit stay, mean duration of orotracheal intubation (OTI) was 15.2 days and 10 patients (71.4%) underwent tracheostomy, which was maintained in 7 for an average of 31 days. According to the European Laryngological Society classification, 13 patients (92.9%) had a grade IIIa LTS and one a grade IIIa+. All patients underwent Type A TRA, according to the authors’ classification. No major perioperative complications were reported and at the last follow-up all patients were asymptomatic.ConclusionsWith the appropriate indications, TRA represents an effective treatment in post-COVID-19 LTS patients. Short OTI times and careful tracheostomy are required in order to reduce the incidence of airway injury.

Editorial introductions.

Current Opinion in Otolaryngology & Head and Neck Surgery was launched in 1993. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of otolaryngology and head and neck surgery are divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Cesare PiazzaCesare PiazzaCesare Piazza, MD, born in Cremona in 1971, has been Full Professor and Chief of the Department of Otorhinolaryngology – Head and Neck Surgery of the University of Brescia, Italy since September 2020. He received his MD degree at the University of Pavia, Italy, in 1996 and completed his residency program in otorhinolaryngology – Head and Neck Surgery in Brescia in 2001. He became Assistant Professor in 2007 and Associate Professor, Chief of the Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery of the National Cancer Institute, University of Milan, Italy, in 2017. His clinical and research activities are focused on head and neck oncology, with special emphasis on laryngo-hypopharyngeal, tracheal, oral, thyroid, parotid, sarcoma, laser, and reconstructive microsurgery. Dr Piazza has been an active member of the European Laryngological Society since 2000, part of its Scientific Council since September 2010, and President since May 2021. He has authored or co-authored 207 papers in peer-reviewed journals as well as 76 book chapters. He delivered 864 proffered papers and invited lectures in national and international Congresses and Courses. He has served as Section Editor of Current Opinion in Otolaryngology & Head and Neck Surgery for the Head and Neck Oncology issue since 2010 and has been a member of the journal's Editorial Board since 2013. He has been a member of the Editorial Board of Frontiers in Oncology since 2016 and Acta Otorhinolaryngologica Italica and Frontiers in Otolaryngology – Head and Neck Surgery since 2017. His surgical activity has been always mainly devoted to head and neck cancer treatment, with more than 6,000 surgical procedures performed in this field (of whom nearly 1,200 were free flaps). Alberto PadernoAlberto PadernoDr Alberto Paderno, MD, born in Brescia in 1987, has been a Staff Member in the Department of Otorhinolaryngology – Head and Neck Surgery at the University of Brescia, Italy, since November 2018. He received his MD degree at the University of Brescia, Italy in 2012 and completed his residency programme in otorhinolaryngology – head and neck surgery in Brescia in 2018. He is currently a PhD candidate in the field of artificial intelligence in medicine. His clinical and research activities focus on head and neck oncology, with particular emphasis on laryngeal and hypopharyngeal cancer, oral malignant and potentially malignant disease, and transoral laser microsurgery. He is involved in various international studies in fields ranging from translational research, biomarkers, oncology, head and neck surgery, and artificial intelligence. He has authored or co-authored 78 papers in peer-reviewed journals as well as five book chapters. He has served as Section Editor of Current Opinion in Otolaryngology & Head and Neck Surgery for the Head and Neck Oncology issue, since 2021. He is a member of the Editorial Board of Acta Otorhinolaryngologica Italica and has been a topic Editor in Frontiers in Oncology, since 2020. His surgical activity is mainly focused on head and neck oncology and, in particular, transoral laser microsurgery.

Quantifying the shrinkage of laryngeal laser excisions: a case control study

Heat from transoral laser microsurgery can cause tissue shrinkage, impacting the surgical margin. This study aimed to compare shrinkage between cold steel and carbon dioxide laser resections of laryngeal lesions. A European Laryngological Society type II resection was performed on 10 mm 'lesions' marked on both the true and false folds of fresh-frozen human larynxes; specifically, laser resection was performed on the right side and cold steel resection on the left side. Twenty-eight larynxes were included. Tissue shrinkage was significantly higher in laser resection (35-45 per cent) compared to cold steel resection (8-14 per cent) (p < 0.0001). In most cases, there was no significant difference in shrinkage between true and false fold sites. This study demonstrates that specimen shrinkage is significantly higher in laser resections. This shrinkage will affect the size of the surgical margin; surgeons and pathologists should be aware of this when considering positive and close margins.

Editorial introductions.

Editorial introductions.

Evaluation of laryngeal vascular changes with image1 s enhancement system in reference to the European laryngological society guideline.

To assess the feasibility of using Image1 S™ endoscopic enhancement system for discrimination of the vascular patterns in laryngeal lesions. Forty patients presenting with benign, dysplastic and malignant laryngeal lesions were examined with Image1 S system. The vascular patterns were classified by a group of authors according to the European Laryngological Society (ELS) guideline, as perpendicular or longitudinal, in all lesions. The relationship between the vascular patterns and the pathological results was statistically analysed. Endoscopic images of the lesions were evaluated through an online survey by a group of otolaryngologists with different levels of clinical expertise and asked them to choose a diagnosis and a vascular pattern. The vascular pattern evaluations of the participants were compared to the authors' evaluations to determine the interobserver reliability. The final diagnostic judgements of the participants were compared with the definitive histopathological diagnoses. Tertiary university hospital. Forty patients with laryngeal lesions and thirty otolaryngologists with different clinical experience levels. The study evaluates the usefulness of the Image1 S system for the detecting the vascular patterns associated with benign, dysplastic, and malignant lesions and measures the level of accuracy and inter observer agreement in detecting the final histopathology. Histopathological examination diagnosed 12 patients as benign, 12 dysplastic and 16 malignant. Using Image1 S, the vascular patterns were longitudinal in 11 lesions, perpendicular in 28 lesions and undetectable in 1 lesion. With white light, longitudinal pattern was observed in 14 lesions, perpendicular in 21 lesions and undetectable in 5 lesions. The correlation between the vascularisation pattern and the pathological diagnosis was found to be significant (p<.001). The qualitative evaluation of the vascular patterns by the two groups of observers showed significant reliability (κ=0.63, p<.001). The agreement with the final diagnoses was also significant (κ=0.56, p<.001). Image1 S endoscopic enhancement system with spectral modes provides an improved visibility of the vascular patterns defined by the ELS in laryngeal lesions. ELS classification can reliably distinguish benign lesions from suspected ones and can be applied even by less-experienced clinicians but the final diagnosis needs experience and should be confirmed with histopathology.