COMPARATIVE EVALUATION OF CLINICAL OUTCOMES AND VOICE QUALITY FOLLOWING CO₂ LASER EXCISION VERSUS CONVENTIONAL LARYNGEAL MICROSURGERY IN PATIENTS WITH VOCAL CORD POLYPS
Keywords:
Vocal Cord Polyps, CO₂ Laser Excision, Laryngeal Microsurgery, Voice Quality, Hoarseness, LaryngoscopyAbstract
Background: Polyps on the vocal cords are non-cancerous growths in the larynx. Chronic vocal abuse or injury, excessive coughing, inappropriate vocal use for extended periods (phonotrauma) or prolonged inflammation are typically the cause of this type of growth in most individuals. Symptoms caused by the presence of these growths include persistent voice fatigue, decreased vocal quality and/or ongoing hoarseness which can greatly affect an individual's ability to communicate effectively as well as their quality of life. Treatment usually consists of surgical excision of vocal cord polyps when conservative treatments have failed to resolve the patient's problem. Conventionally, laryngeal microsurgical techniques were the preferred method of surgical removal of vocal cord polyps. However, recent technological advances have allowed surgeons to utilize carbon dioxide (CO₂) lasers for the incision/excision of these polyps while minimizing blood loss and trauma to surrounding tissues during the procedure. The CO₂ laser may also improve the outcome of voice surgery by providing a more precise incision and reduced recovery time compared to traditional microsurgical procedures. Aim: To compare the clinical outcomes and voice quality following CO₂ laser excision versus conventional laryngeal microsurgery in patients with vocal cord polyps.
Methods: The conducted clinical study was a comparative analysis, lasted for 1 year between January 2024 until December 2024 and had 100 vocally cord polyp patients included. The patients were separated into two groups; 50 CO₂ laser excisions treated patients and 50 surgical conventional laryngeal microsurgical procedure treated patients. Patients were evaluated preoperatively through clinical examinations, laryngoscopic evaluations, and voice analysis. Results were obtained from both groups based on voice quality improvements, symptom improvements, and postoperative complication rates. The patients’ voice quality evaluations were based upon a standardized voice evaluation parameter, measured during the patient follow-up evaluations.
Results: Compared to those who underwent traditional methods via laryngeal microsurgery, patients receiving treatment through CO₂ laser excision experienced quicker improvement of voice quality after surgery as well as more rapid symptom resolution. In addition, the CO₂ laser excision group experienced lower levels of bleeding during surgery than patients receiving traditional laryngeal microsurgery, allowing for shorter recovery periods. Post-op complications were minimal across both patient groups; however some patients did report experiencing transient hoarseness along with very mild post-operative swelling.
Conclusion: The CO₂ Laser Excision of Vocal Cord Polyps is a new and safe method for removing Vocal Cord Polyps. The CO₂ Laser method gives the surgeon greater control over the procedure, a higher chance of achieving a good voice outcome, and a shorter time period before return to normal function compared to traditional laryngeal microsurgery. Thus, the removal of Vocal Cord Polyps with the CO₂ Laser is a new and safe option for orthopedic surgeons and voice specialists in the treatment of patients with vocal cord polyps.
References
1. Zhang L. Analysis of the clinical efficacy and voice outcomes of CO2 laser resection versus laryngeal microsurgery for vocal cord polyps. Ann Med. 2023;55(2):2280228. doi: 10.1080/07853890.2023.2280228. Epub 2023 Nov 27. PMID: 38010099; PMCID: PMC10836248.
2. Hong YT, Hong KH. Localized Laryngeal Amyloidosis-Transoral Laser Excision. Ear Nose Throat J. 2020 Jun;99(5):298-299. doi: 10.1177/0145561319840233. Epub 2019 Apr 28. PMID: 31032656.
3. Solarz P, Mackiewicz-Nartowicz H, Sinkiewicz A, Burduk P. Results of CO2 laser surgery in laryngeal papillomatosis. Oral Oncol. 2024 Nov;158:107004. doi: 10.1016/j.oraloncology.2024.107004. Epub 2024 Aug 19. PMID: 39163742.
4. Abi Zeid Daou C, Ghanem A, Hosri J, Abou Raji Feghali P, Hamdan AL. Office-Based Laser Therapy in Vocal Fold Polyps: A Systematic Review and Meta-Analysis. J Voice. 2025 Sep;39(5):1357-1367. doi: 10.1016/j.jvoice.2023.03.003. Epub 2023 Mar 31. PMID: 37003865.
5. Mesolella M, Allosso S, Mansueto G, Fuggi M, Motta G. Strategies and Controversies in the Treatment With Carbon Dioxide Laser of Laryngeal Hemangioma: A Case Series and Review of the Literature. Ear Nose Throat J. 2022 Jun;101(5):326-331. doi: 10.1177/0145561320952191. Epub 2020 Sep 13. PMID: 32921178.
6. Ryabova MA, Ulupov MY, Malkova ME, Stepanova VA. Polipy golosovykh skladok: sovremennye vozmozhnosti lazernoi khirurgii v sravnenii s ispol'zovaniem kholodnykh mikroinstrumentov [Vocal fold polyps: modern possibilities of laser surgery in comparison with the use of cold microinstruments]. Vestn Otorinolaringol. 2023;88(4):40-45. Russian. doi: 10.17116/otorino20228804140. PMID: 37767589.
7. Chadwick KA, Andreadis K, Sulica L. Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps. Laryngoscope. 2024 Aug;134 Suppl 8:S1-S20. doi: 10.1002/lary.31484. Epub 2024 May 14. PMID: 38742623.
8. Nerurkar NK, Shah K, Patel K, Muzumdar G. A Retrospective Study to Assess the Accuracy of Frozen Sections in Laser Laryngeal Surgery. Ann Otol Rhinol Laryngol. 2023 Sep;132(9):1096-1101. doi: 10.1177/00034894221136332. Epub 2022 Nov 14. PMID: 36377079.
9. Wang HZ, Liu XY, Li XY, Cheng LY, Hu R, Yang QW, Li YR, Xu W. [Analysis of long-term efficacy of CO2 laser partial excision of vocal folds for 599 cases in the treatment of vocal cord leukoplakia]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Oct 7;59(10):1029-1036. Chinese. doi: 10.3760/cma.j.cn115330-20240720-00432. PMID: 39449598.
10. Del Corso G, Gissi DB, Tarsitano A, Costabile E, Marchetti C, Montebugnoli L, Foschini MP. Laser evaporation versus laser excision of oral leukoplakia: A retrospective study with long-term follow-up. J Craniomaxillofac Surg. 2015 Jul;43(6):763-8. doi: 10.1016/j.jcms.2015.04.009. Epub 2015 Apr 17. PMID: 25979576.
11. Lin S, Lin Q, Huang X, Yu Q, Wang D. Surgical management of broad-based sessile vocal cord polyps: Transnasal vocal fold polypectomy versus microlaryngoscopic surgery: Our experience in 159 cases. Clin Otolaryngol. 2023 Nov;48(6):902-908. doi: 10.1111/coa.14090. Epub 2023 Aug 2. PMID: 37532258.
12. Lim JY, Park YM, Kang M, Lee SJ, Baek K, Na J, Choi HS. Angiolytic laser stripping versus CO2 laser microflap excision for vocal fold leukoplakia: Long-term disease control and voice outcomes. PLoS One. 2018 Dec 31;13(12):e0209691. doi: 10.1371/journal.pone.0209691. PMID: 30596718; PMCID: PMC6312374.
13. Mizuta M, Hiwatashi N, Kobayashi T, Kaneko M, Tateya I, Hirano S. Comparison of vocal outcomes after angiolytic laser surgery and microflap surgery for vocal polyps. Auris Nasus Larynx. 2015 Dec;42(6):453-7. doi: 10.1016/j.anl.2015.03.011. Epub 2015 Apr 28. PMID: 25933587.
14. Wang G, Bing D, Chen X, Dong P. [Applying a rigid curved video laryngoscope in laryngeal microsurgery of patients with difficult laryngeal exposure]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jun;36(6):463-466. Chinese. doi: 10.13201/j.issn.2096-7993.2022.06.011. PMID: 35822366; PMCID: PMC10128495.
15. Lombardo N, Lobello N, Piazzetta G, Ciriolo M, Pelaia C, Testa D, Motta G. Intrinsic Laryngeal Lipoma Treated with Transoral CO₂ Laser Microsurgery: An Unusual Case Report. Am J Case Rep. 2020 Jul 3;21:e920528. doi: 10.12659/AJCR.920528. PMID: 32619210; PMCID: PMC7360360.
16. Fraser L, Kelly G, MacLennan K, Makura ZG. Severe laryngeal dysplasia in a 20-year-old nonsmoker treated with CO2 laser excision: a case report and review of the literature. Photomed Laser Surg. 2010 Oct;28 Suppl 2:S115-9. doi: 10.1089/pho.2009.2502. Epub 2010 Sep 23. PMID: 20860544.
17. Öztürk K, Öztürk A, Turhal G. En Bloc Resection of Supraglottic Carcinomas with Transoral Laser Microsurgery. Turk Arch Otorhinolaryngol. 2021 Dec;59(4):282-288. doi: 10.4274/tao.2021.2021-8-13. Epub 2022 Feb 22. PMID: 35262045; PMCID: PMC8864201.
18. Higgins KM. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope. 2011 Jan;121(1):116-34. doi: 10.1002/lary.21226. PMID: 21120828.
19. Cai H, Tang A, Xu Z, Su J, Zhou Y, Nong D. [Analysis of the reason for the adhesion of vocal cord after CO2 laser laryngeal surgery]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010 Feb;24(4):147-8, 151. Chinese. PMID: 20422975.
20. Wang H, Zhuge P, You H, Zhang Y, Zhang Z. Comparison of the efficacy of vocal training and vocal microsurgery in patients with early vocal fold polyp. Braz J Otorhinolaryngol. 2019 Nov-Dec;85(6):678-684. doi: 10.1016/j.bjorl.2018.03.014. Epub 2018 May 9. PMID: 29784620; PMCID: PMC9443021.
