Table 3.
Published vocal outcomes for T1a glottic cancer treated with TOLMS, taken from representative studies (last 14 years, n > 10 T1a patients operated via TOLMS).
| Study | Numbers | Parameters for Evaluation of Vocal Function | Vocal Outcome after Transoral Lasermicrosurgery (TOLMS) | ||
|---|---|---|---|---|---|
| Clinician-Rated Assessment (Subjective) |
Patient’s Self-Assessment (Subjective) |
Acoustic-Aerodynamic Evaluation (Objective) |
|||
| Hamzany et al. (2021) [70] | 27 T1a | GRB | VHI | F0, jitter, shimmer, NHR, MPT |
significant subjective improvement, no objective improvement |
| Strieth et al. (2019) [76] | 14 T1a | – | VHI | – | improved voice preservation by KTP-TOLMS (lower VHI scores) compared to CO2-TOLMS (higher VHI scores) |
| Gandhi et al. (2018) [59] | 40 T1a + b (N/S) |
GRBAS | VHI | F0, jitter, shimmer, SPI, NHR |
excellent vocal outcome (G 0.63, VHI 13); no pretherapeutic data |
| Hong et al. (2018) [61] | 14 T1a + b (N/S) |
GRBAS | – | F0, jitter, shimmer, NHR |
GRB with mild dysphonia, Jitter 2.37%; no pretherapeutic data |
| Lee et al. (2016) [71] | 50 T1a | GRBAS | VHI | F0, jitter, shimmer, NHR, voice intensity, MPT |
G significantly improved; voice quality improved over time in limited ELS resections (I-II) but not in extended cordectomies (III-V) |
| Fink et al. (2016) [72] | 38 T1a | VAS (0–100) | VHI | – | similar or improved voice in limited ELS resections (I-III), VHI improved significantly (VAS n.s.); poorer outcomes in extended resections |
| Kono et al. (2016) [62] | 64 T1a | GRBAS | VHI, V-RQOL | F0, jitter, shimmer, NHR, MPT |
mild to moderate impairment (GRB, VHI, jitter), better improvement over time in focused excision compared to defocused vaporization |
| Berania et al. (2015) [65] | 18 T1a | PSS-H&N | VHI-10 | – | favorable functional outcomes (40% mild voice handicap, VHI-10 > 11); no pretherapeutic data |
| Bertino et al. (2015) [66] | 135 T1a | degree of dysphonia (acc. Ricci Maccarini) | – | F0, HNR | mild to slight dysphonia in limited ELS resections (I-II), moderate to severe dysphonia in extended resections (III-V); no pretherapeutic data |
| Laoufi et al. (2014) [57] | 44 T1a | – | VHI, EORTC QLQ-HN35 | – | VHI score mild to moderate impaired (mean 29); no pretherapeutic data |
| Friedman et al. (2013) [77] | 57 T1a | – | V-RQOL | F0, jitter, shimmer, NHR, max. SPL range, max. F0 range, SPL divided by subglottic pressure | significant improvement of subjective (V-RQOL) and most objective (acoustic, aerodynamic) measures |
| Tomifuji et al. (2013) [73] | 33 T1a | GRBAS | VHI | jitter, shimmer, HNR, MPT, MFR |
voice quality differs according to the type of cordectomy; no pretherapeutic data |
| van Gogh et al. (2012) [60] | 67 T1a | – | – | F0, jitter, shimmer, NNE | quick voice outcome recovery apart from F0 (remains higher pitched), no significant long-term voice changes |
| Bajaj et al. (2011) [67] | 14 T1a + b (N/S) |
GRBAS | VoiSS, UW-QoL | F0, F0 irregularity, CQ range, CQ irregularity |
preservation of acceptable vocal function (GRB mild to moderate impaired, low VoiSS score); no pretherapeutic data |
| Keilmann et al. (2011) [68] | 11 T1a | RBH | VHI-12 | F0, jitter, shimmer, MPT, GHD, VRP |
discrepancy over time (VHI deteriorated; RBH and objective measures improved); no pretherapeutic data |
| Lester et al. (2011) [78] | 19 T1a + b (N/S) |
– | ordinal scale (1–5) |
F0, jitter, shimmer, MPT | objective acoustic measures showed no significant changes; deterioration of MPT (13s to 12s) and subjective rating score (3 to 2) |
| Motta et al. (2008) [69] | 49 T1a | – | – | MPT HNR, average voice intensity |
outcomes vary in relation to the main site of the pseudo-glottis, vocal compensation without normal voice quality; no pretherapeutic data |
| Núñez Batalla et al. (2008) [63] | 19 T1a | GRBAS | VHI | F0, jitter, shimmer, NNE, MPT | mild to moderate impairment (GRBAS, VHI); no pretherapeutic data |
| Sjögren et al. (2008) [64] | 18 T1a | GRBAS | VHI | F0, jitter, shimmer, intensity, MPT, VC, phonation quotient | mild to moderate voice dysfunction (G, B, VHI) in ca. half of patients; no pretherapeutic data |
| Vilaseca et al. (2008) [79] | 35 T1a | GRBAS | ordinal scale (1–3) |
F0, jitter, shimmer, NHR, vocal range, MPT |
self-assessed improvement; compared with healthy controls: increase of F0, jitter, shimmer (MPT decrease in extended resections); no pretherapeutic data |
| Roh et al. (2007) [75] | 50 T1a | GRBAS | VHI, EORTC QLQ-HN35 | F0, jitter, shimmer, HNR, MPT, average airflow |
improved vocal outcomes, significant in type I and II cordectomies (VHI, G, jitter, shimmer, HNR) |
Legend: CQ—closed quotient, EORTC QLQ-HN35—European Organization for Research and Treatment of Cancer Head and Neck Quality of Life questionnaire; F0—fundamental frequency; GHD—Goettinger Hoarseness Diagram; GRBAS—overall Grade, Roughness, Breathyness, Asthenia, Strain; NHR—harmonics-to-noise ratio; KTP—Potassium titanyl phosphate; MFR—mean flow rate; MPT—maximum phonation time; NHR—noise-to-harmonic ratio; NNE—normalized noise energy; N/S—not specified; PSS-H&N—performance status scale for head & neck cancer patients; RBH—Roughness, Breathyness, (overall grade of) Hoarseness; SNR—signal to-noise ratio; SPI—soft phonation index; SPL—sound pressure level; UW-QoL—University of Washington Quality of Life questionnaire; VAS—visual analogue scale; VC—vital capacity; VHI—voice handicap index; VHI-10—10-item VHI; VHI-12—12-item VHI; VoiSS—voice symptom scale; VRP—voice range profile; V-RQOL—Voice-Related Quality-of-Life survey.