Comparative analysis of voice quality in patients with benign vocal fold lesions after direct laryngomicroscopy and indirect laryngoscopic surgery

[O. D. Čukić]

53 str.

medicina - rekonstruktivna hirurgija / medicine - reconstructive surgery

Benigni izraštaji glasnica predstavljaju najčešći uzrok dugotrajne promuklosti i rešavaju se direktnom laringomikroskopijom (LMS) u opštoj endotrahealnoj anesteziji kada je hirurško lečenje indikovano. Pre uvoĎenja LMS, benigni izraštaji glasnica su uklanjani indirektnom laringoskopskom hirurgijom (ILH) u lokalnoj anesteziji, tehnički zahtevnom procedurom koja se obavljala pod kontrolom laringealnog ogledalca i bez uveličanja. Razvojem beţičnih tehnologija i ambulantne endoskopije larinksa, upotrebili smo rigidni faringolaringoskop i beţičnu kameru povezanu sa računarom da bismo olakšali izvoĎenje ILH. Cilj ove studije je bio da proceni efikasnost ILH poreĎenjem glasovnih ishoda sa LMS. U studiju je uključeno 12 pacijenata sa benignim izraštajima glasnica, od kojih je šestoro operisano ILH-om, a šestoro LMS-om. Ishodi lečenja su mereni samoocenjivanjem i objektivnom akustičkom analizom glasa, uključujući parametre jitter, shimmer i odnos harmonika prema šumu. TakoĎe, ispitivana je i korelacija dobijenih vrednosti glasovnih parametara sa kliničkim karakteristikama (oblik, veličina) i patohistološkim nalazima odstranjenih promena glasnica. Za svaku hiruršku intervenciju izračunati su ukupni troškovi izvoĎenja. Obe hirurške tehnike omogućile su uspešno uklanjanje promena glasnica kod svih pacijenata, bez statistički značajne razlike u ispitivanim parametrima glasa. Preoperativni skorovi samoocenjivanja glasa i postoperativni jitter bili su veće kod pacijenata sa sesilnim promenama. Prosečni troškovi lečenja bili su značajno manji kod ILH. Uprkos malom broju ispitanika, prikupljeni podaci ukazuju na potencijalnu vrednost ILH, koja bi se mogla koristiti kao alternativa LMS kod paţljivo odabranih pacijenata imajući u vidu njenu tehnološku jednostavnost i ekonomsku isplativnost.

Benign vocal fold lesions (BVFLs) are the leading cause of long-standing hoarseness and are managed by microlaryngoscopy (MLS) in general anesthesia when surgery is indicated. Before the introduction of MLS, BVFLs were removed using indirect laryngoscopic surgery (ILS) in local anesthesia, a procedure that required substantial surgical skill to operate with an unmagnified mirror view of the larynx. Regarding the technological development of ambulatory laryngeal endoscopy, we have used pharyngolaryngoscope and a wireless camera to greatly facilitate ILS. This study aimed to assess the effectiveness of ILS by comparing voice outcomes with MLS. A total of twelve patients with BVFLs were selected for the study. ILS and MLS were performed in six patients each. Treatment outcomes were measured using a voice self-assessment and objective acoustic analysis, including jitter, shimmer, and harmonics-to-noise ratio parameters. The correlation of measured voice parameters with the clinical characteristics (shape, size) and pathology of the excised lesions was also assessed. The total cost of both procedures was calculated. Both techniques allowed the successful removal of BVFs in all patients, without significant intergroup differences in voice outcomes. Preoperative voice self-assessment scores and postoperative jitter values were higher in patients with sessile lesions. The cost of ILS was significantly lower than LMS. Despite the small sample size, the collected data indicate the potential value of ILS which, considering its simplicity and economic value, could be used as an alternative to MLS in carefully selected patients.

laringomikroskopija, indirektna laringoskopska hirurgija, benigne promene glasnica, polipi glasnica, ambulantna hirurgija larinksa

microlaryngoscopy, indirect laryngeal surgery, benign vocal fold lesions, vocal fold polyps, office-based laryngeal surgery

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