Voice Outcomes Following Repeated Surgical Resection of Laryngeal Papillomata in Children

OBJECTIVES: 1) To apply perceptual and acoustic voice assessments to children treated for juvenile-onset recurrent respiratory papillomatosis (JORRP); 2) to compare voice outcomes following treatment for JORRP using microdebrider versus carbon dioxide (CO₂) laser.

STUDY DESIGN: Prospective cohort study.

SETTING: This study was conducted at a tertiary pediatric academic center (March 2008-March 2009).

SUBJECTS AND METHODS: Children with active JORRP were assessed using perceptual and acoustic voice analysis following treatment with either CO₂ laser or microdebrider. Outcome measures included overall severity rating, jitter, shimmer, and noise-to-harmonic ratio (NHR). The unpaired Student t test and Pearson correlation tests were used to explore the statistical significance of hypothesis tests.

RESULTS: Eleven patients (8 male, 3 female) aged three to 17 years were enrolled. There were six children in the CO₂ laser cohort and five children in the microdebrider cohort. The immediate postoperative scores were significantly lower in the microdebrider cohort (vs the CO₂ cohort) for jitter, shimmer, NHR, and perceptual scores (P < 0.05), indicating a better voice quality in the microdebrider group. Jitter, shimmer, and NHR showed a significant positive correlation with the proportion of CO₂ laser procedures (P < 0.05).

CONCLUSION: This is the first study to use perceptual and objective acoustic evaluations to compare voice outcomes following microdebrider or CO₂ laser treatment of JORRP. The results of this study suggest that treatment with the microdebrider results in a better immediate and early postoperative voice outcome. Moreover, the data demonstrate a correlation of worsening voice quality with increased exposure to the CO₂ laser.