Long-Term Voice Outcomes After Trans-Oral Resection of Early Glottis Carcinoma.

Abstract

Survival after trans-oral laser microsurgery (TLM) for glottic carcinoma is excellent. However, the voice quality after TLM remains unclear. This study examines voice outcomes following different surgical procedures. A retrospective study of voice outcomes (GRBAS, VHI-10, CSID scores) after TLM. Patients undergoing TLM were studied. We collected the Voice Handicap Index (VHI-10), acoustic analysis (Cepstral Spectral Peak Prominence, CSPP score), and GRBAS rating score. These data were correlated with cancer stage and ELS (surgery type). We studied 102 patients (86 males, 16 females; median age 74). There were 51 type I and 27 type Va resections. The rest underwent types II, III, IV, Vb, VI, and open vertical hemilaryngectomy surgery. The median follow-up time was 5.2 years. The median VHI-10 score was 7.5 (normal < 10). The median CSID score was 27.5 (mild = 20-40). The Average GRBAS score was G1.5, R1, B1, A0, S1.5 (mild = 1, moderate = 2). There was a correlation between the CSID score and the type of cordectomy and surgical stage. There was a statistical difference in Type I ELR resection outcomes compared with all other types in voice outcome (Cohen's d-value > 0.5). Patients often rate their VHI as normal, while objective and perceptual raters rate voices after TLM as showing mild to moderate dysphonia. This low VHI score may be due to cancer survivorship. Understanding the patient experience after TLM surgery and knowing the extent of surgery on voice outcomes can help better counsel patients undergoing TLM.