{"title":"在办公室KTP激光手术良性声带病变东亚患者：语音结果和程序耐受。","authors":"Ji-Hoon Kim","doi":"10.1016/j.jvoice.2025.09.034","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>To determine whether in-office potassium-titanyl-phosphate (KTP) laser surgery provides significant voice improvement and acceptable tolerance in East Asian patients with benign vocal-fold lesions.</p><p><strong>Study design: </strong>Retrospective single-center cohort (Level IV).</p><p><strong>Methods: </strong>Eighty-two consecutive adults (mean ± SD = 43.7 ± 13.7 years) underwent in-office KTP laser surgery under topical anesthesia between March 2024 and February 2025. Preoperative/postoperative assessments included the Voice Handicap Index (VHI), jitter, shimmer, soft-phonation index (SPI), noise-to-harmonics ratio (NHR), and videostroboscopy (glottic closure, mucosal wave, each graded on a 0-3 ordinal scale) by a single board-certified otolaryngologist, and tolerance metrics-nasal pain, throat pain, and gag-reflex intensity measured on a 0-10 visual analogue scale (VAS), and willingness-to-repeat/-recommend measured on a 0-10 numeric rating scale (NRS). Wilcoxon signed-rank tests and Spearman correlations were applied.</p><p><strong>Results: </strong>VHI improved by -33 points (95% CI -40.6 to -25.4; P < 0.001). Jitter, shimmer, and SPI fell by 36%, 41%, and 29%, respectively (P ≤ 0.004); NHR showed no significant change. Videostroboscopy confirmed better glottic closure (+1.33) and mucosal wave (+0.47; P < 0.001). Mean nasal pain 2.95 ± 1.50, throat pain 2.14 ± 1.67, and gag reflex 2.67 ± 1.80 were modest; willingness-to-repeat and-recommend were 8.16 ± 2.27 and 7.26 ± 1.76. Nasal pain (ρ = -0.50) and gag reflex (ρ = -0.75) inversely correlated with willingness scores (P < 0.001); discomfort did not correlate with voice gains.</p><p><strong>Conclusion: </strong>In-office KTP laser surgery yields robust, clinically meaningful voice improvement in East Asian patients while maintaining good patient acceptance. Optimizing topical anesthesia-particularly for patients with narrow nasal passages or septal spurs-may further enhance tolerance without compromising efficacy.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"In-Office KTP Laser Surgery for Benign Vocal Fold Lesions in East Asian Patients: Voice Outcomes and Procedural Tolerance.\",\"authors\":\"Ji-Hoon Kim\",\"doi\":\"10.1016/j.jvoice.2025.09.034\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives/hypothesis: </strong>To determine whether in-office potassium-titanyl-phosphate (KTP) laser surgery provides significant voice improvement and acceptable tolerance in East Asian patients with benign vocal-fold lesions.</p><p><strong>Study design: </strong>Retrospective single-center cohort (Level IV).</p><p><strong>Methods: </strong>Eighty-two consecutive adults (mean ± SD = 43.7 ± 13.7 years) underwent in-office KTP laser surgery under topical anesthesia between March 2024 and February 2025. Preoperative/postoperative assessments included the Voice Handicap Index (VHI), jitter, shimmer, soft-phonation index (SPI), noise-to-harmonics ratio (NHR), and videostroboscopy (glottic closure, mucosal wave, each graded on a 0-3 ordinal scale) by a single board-certified otolaryngologist, and tolerance metrics-nasal pain, throat pain, and gag-reflex intensity measured on a 0-10 visual analogue scale (VAS), and willingness-to-repeat/-recommend measured on a 0-10 numeric rating scale (NRS). Wilcoxon signed-rank tests and Spearman correlations were applied.</p><p><strong>Results: </strong>VHI improved by -33 points (95% CI -40.6 to -25.4; P < 0.001). Jitter, shimmer, and SPI fell by 36%, 41%, and 29%, respectively (P ≤ 0.004); NHR showed no significant change. Videostroboscopy confirmed better glottic closure (+1.33) and mucosal wave (+0.47; P < 0.001). Mean nasal pain 2.95 ± 1.50, throat pain 2.14 ± 1.67, and gag reflex 2.67 ± 1.80 were modest; willingness-to-repeat and-recommend were 8.16 ± 2.27 and 7.26 ± 1.76. Nasal pain (ρ = -0.50) and gag reflex (ρ = -0.75) inversely correlated with willingness scores (P < 0.001); discomfort did not correlate with voice gains.</p><p><strong>Conclusion: </strong>In-office KTP laser surgery yields robust, clinically meaningful voice improvement in East Asian patients while maintaining good patient acceptance. Optimizing topical anesthesia-particularly for patients with narrow nasal passages or septal spurs-may further enhance tolerance without compromising efficacy.</p><p><strong>Level of evidence: </strong>Level IV.</p>\",\"PeriodicalId\":49954,\"journal\":{\"name\":\"Journal of Voice\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-10-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Voice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jvoice.2025.09.034\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Voice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jvoice.2025.09.034","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的/假设：确定办公室内磷酸钛钾（KTP）激光手术是否能显著改善东亚良性声带病变患者的声音和可接受的耐受性。研究设计：回顾性单中心队列（IV级）。方法：于2024年3月至2025年2月，连续82例成人（平均±SD = 43.7±13.7岁）在表面麻醉下行KTP激光手术。术前/术后评估包括由一名认证耳鼻喉科医生进行的语音障碍指数（VHI）、抖动、闪烁、软音指数（SPI）、噪声-谐波比（NHR）和视频频闪检查（声门关闭、粘膜波，每项按0-3的顺序分级），以及容忍度指标——鼻痛、喉咙痛和呕吐反射强度，用0-10的视觉模拟量表（VAS）测量，用0-10的数字评定量表（NRS）测量，重复/推荐的愿意度。采用Wilcoxon符号秩检验和Spearman相关。结果：VHI改善了-33点（95% CI -40.6至-25.4）；P结论：在保持良好的患者接受度的同时，在办公室KTP激光手术中，东亚患者的声音得到了强有力的、有临床意义的改善。优化局部麻醉，特别是对于鼻通道狭窄或鼻中隔刺痛的患者，可以在不影响疗效的情况下进一步增强耐受性。证据等级：四级。
In-Office KTP Laser Surgery for Benign Vocal Fold Lesions in East Asian Patients: Voice Outcomes and Procedural Tolerance.
Objectives/hypothesis: To determine whether in-office potassium-titanyl-phosphate (KTP) laser surgery provides significant voice improvement and acceptable tolerance in East Asian patients with benign vocal-fold lesions.
Study design: Retrospective single-center cohort (Level IV).
Methods: Eighty-two consecutive adults (mean ± SD = 43.7 ± 13.7 years) underwent in-office KTP laser surgery under topical anesthesia between March 2024 and February 2025. Preoperative/postoperative assessments included the Voice Handicap Index (VHI), jitter, shimmer, soft-phonation index (SPI), noise-to-harmonics ratio (NHR), and videostroboscopy (glottic closure, mucosal wave, each graded on a 0-3 ordinal scale) by a single board-certified otolaryngologist, and tolerance metrics-nasal pain, throat pain, and gag-reflex intensity measured on a 0-10 visual analogue scale (VAS), and willingness-to-repeat/-recommend measured on a 0-10 numeric rating scale (NRS). Wilcoxon signed-rank tests and Spearman correlations were applied.
Results: VHI improved by -33 points (95% CI -40.6 to -25.4; P < 0.001). Jitter, shimmer, and SPI fell by 36%, 41%, and 29%, respectively (P ≤ 0.004); NHR showed no significant change. Videostroboscopy confirmed better glottic closure (+1.33) and mucosal wave (+0.47; P < 0.001). Mean nasal pain 2.95 ± 1.50, throat pain 2.14 ± 1.67, and gag reflex 2.67 ± 1.80 were modest; willingness-to-repeat and-recommend were 8.16 ± 2.27 and 7.26 ± 1.76. Nasal pain (ρ = -0.50) and gag reflex (ρ = -0.75) inversely correlated with willingness scores (P < 0.001); discomfort did not correlate with voice gains.
Conclusion: In-office KTP laser surgery yields robust, clinically meaningful voice improvement in East Asian patients while maintaining good patient acceptance. Optimizing topical anesthesia-particularly for patients with narrow nasal passages or septal spurs-may further enhance tolerance without compromising efficacy.
期刊介绍：
The Journal of Voice is widely regarded as the world''s premiere journal for voice medicine and research. This peer-reviewed publication is listed in Index Medicus and is indexed by the Institute for Scientific Information. The journal contains articles written by experts throughout the world on all topics in voice sciences, voice medicine and surgery, and speech-language pathologists'' management of voice-related problems. The journal includes clinical articles, clinical research, and laboratory research. Members of the Foundation receive the journal as a benefit of membership.
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