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In-Office Laryngeal Procedures in Awake Patients a Viable, and Often Preferable, Option

by Heather Lindsey •

Generally, patients won’t need narcotics for pain or antibiotics to prevent infection postprocedure. They may, however, need to refrain from taking aspirin or anticoagulants beforehand.

They should also expect a minor sore throat afterward, which can be treated with acetaminophen or ibuprofen, said Dr. Johns.

Mild injury to structures of the nose and mouth may occur but are rare. Any time you work on the voice box, whether with injection or laser, there’s always a risk of scarring, hoarseness, and recurrence of the problem, Dr. Klein explained.

Individuals can also experience a reaction to injection materials, airway compromise, infection, bleeding, or swelling from procedures, although such reactions are rare.

They should also anticipate their voice to wax and wane in clarity for a couple of weeks (whether after an injection or a laser procedure) due to swelling. Voice rest is necessary with laser procedures but not with injection.

Finally, if patients are coughing up blood or having problems breathing, they should come back into the hospital immediately.

Most Patients Prefer Awake Procedures

In addition to the effectiveness of many in-office awake laryngeal procedures, the majority of patients appear prefer this type of treatment versus being in the operating room under full sedation, said Dr. Postma, citing a study of which he was a co-author.12

He and his colleagues studied 131 patients who had 328 unsedated in-office PDL procedures. Eighty-nine of these patients who completed a phone survey reported an average comfort score of 7.4, with 10 representing minimal discomfort. Eighty-seven percent said they would rather have an unsedated in-office procedure than surgery under general anesthesia for any further treatment of their disease.

Patients with recurrent papillomas had to be treated in the operating room three or four times a year, explained Dr. Postma. They love that they can be treated in-office now, he said.

Another reason patients may prefer in-office awake procedure is that they don’t have to take three or four days off from work, noted Dr. Klein.

Older individuals especially want to avoid surgery, commented Dr. Zeitel. Patients benefit from not having an extensive presurgical workup, and they avoid general anesthesia. Moreover, because less surgery takes place, there is often less voice rest, he said.

References

  1. Zeitels SM, Franco RA Jr, Dailey SH, et al. Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia. Ann Otol Rhinol Laryngol 2004;113:265-76.
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  2. Zeitels SM, Akst LM, Burns JA, et al. Office-based 532-nm pulsed KTP laser treatment of glottal papillomatosis and dysplasia. Ann Otol Rhinol Laryngol 2006;115:679-85.
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  3. Broadhurst MS, Akst LM, Burns JA, et al. Effects of 532 nm pulsed-KTP laser parameters on vessel ablation in the avian chorioallantoic membrane: implications for vocal fold mucosa. Laryngoscope 2007;117:220-5.
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  7. Bouchayer M, Cornut G. Microsurgical treatment of benign vocal fold lesions: indications, technique, results. Folia Phoniatr 1992;44:155-84.
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  8. Hochman II, Zeitels SM. Phonomicrosurgical management of vocal fold polyps: the subepithelial microflap resection technique. J Voice 2000;14:112-8.
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  9. Zeitels SM, Hillman RE, Desloge R, et al. Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions. Ann Otol Rhinol Laryngol Suppl 2002;190:21-40.
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  10. Zeitels SM, Burns JA, Lopez-Guerra G, et al. Photoangiolytic laser treatment of early glottic cancer: a new management strategy. Ann Otol Rhinol Laryngol Suppl 2008; 199:1-24.
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  11. Rees CJ, Postma GN, Koufman JA. Cost savings of unsedated office-based laser surgery for laryngeal papillomas. Ann Otol Rhinol Laryngol 2007;116:45-8.
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  12. Rees CJ, Halum SL, Wijewickrama RC, Koufman JA, Postma GN. Patient tolerance of in-office pulsed dye laser treatments to the upper aerodigestive tract. Otolaryngol Head Neck Surg 2006;134:1023-7.
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