title: The use of the pulse dye laser in the treatment of vocal fold scar: a preliminary study.
abstract: OBJECTIVE
  Dysphonia due to vocal fold scarring is a challenging problem to the laryngologist. Vocal fold scarring after radiation, phonosurgery, and laser cordectomy causes moderate to severe dysphonia. Surgical attempts at scar removal and voice restoration have limited success. Pulsed dye laser (PDL) treatment has been shown to be effective in softening scarred skin by serial office treatments. The objective of this preliminary study was to evaluate the use of the PDL in the management of patients with established vocal fold scar.
  
  
  METHODS
  This is an Institutional Review Board-approved prospective study involving 11 patients. The causes of scarring were phonosurgery (n = 7), radiation (n = 2), and partial laryngectomy (n = 2). The subjects were evaluated pre- and postprocedure using the voice handicap index (VHI), laryngeal stroboscopy rating, voice recordings with acoustic and aerodynamic analysis, and self-evaluation.
  
  
  METHODS
  The PDL was applied with the fiberoptic delivery system by three treatments at 1-month intervals in the office setting. Each treatment endpoint was blanching of the treatment site.
  
  
  RESULTS
  : There were three women and eight men in our study group. Ten of 11 patients subjectively improved by self-rating. No patients were worse. VHI improved from 48.44 pretreatment to 35.55 at 6 months posttreatment (P < .05). The jitter at 6 months improved from 2.230% to 1.654% (P = NS) and shimmer improved from 3.679% to 3.196% (P = NS). The noise to harmonic ration improved from 0.1428 to 0.1316 (P = NS). The mean phonotory flow went from 0.177 to 0.254 L/S (P < .05). Three raters blinded to treatment sequence rated the posttreatment stroboscopy findings as better than pretreatment in a forced choice comparison, kappa score 0.903.
  
  
  CONCLUSIONS
  PDL is a safe and potentially promising treatment for established vocal fold scar. Subjectively, no patients were worse and 10 of 11 patients reported improved voice. There was improvement in the VHI, acoustic measures of shimmer and jitter, and stroboscopy findings. Further study using this approach in a larger cohort seems to be warranted.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York 10029, USA. melissa.mortensen@mssm.edu
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Mortensen
authors.forename: Peak
authors.initials: P
authors.lastname: Woo
authors.forename: Chandra
authors.initials: C
authors.lastname: Ivey
authors.forename: Chandler
authors.initials: C
authors.lastname: Thompson
authors.forename: Linda
authors.initials: L
authors.lastname: Carroll
authors.forename: Kenneth
authors.initials: K
authors.lastname: Altman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D054025:Lasers, Dye; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013061:Speech Acoustics; D014827:Vocal Cords / Q000293:injuries* / Q000473:pathology / Q000528:radiation effects; D014832:Voice Disorders / Q000209:etiology / Q000532:radiotherapy*; D014833:Voice Quality