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 (CO(2)) 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 CO(2) 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 CO(2) laser cohort and five children in the microdebrider cohort. The immediate postoperative scores were significantly lower in the microdebrider cohort (vs the CO(2) 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 CO(2) 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 CO(2) 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 CO(2) laser.