A Comparison of Two Endoscopic Posterior Cordotomy Techniques: Laser Cordotomy vs Diathermy Assisted Cordotomy

Abstract

Objectives

To compare respiratory function, swallowing and voice quality of bilateral abductor vocal fold paralysis (BAVFP) patients undergoing laser and diathermy assisted posterior cordotomy.

Design

Prospective study.

Setting

Tertiary academic hospital.

Participants

Thirty patients were included in the study (Group 1 and 2, 15 patients each). Mean age was 53±14.27 years with a range of 31-78 years (12 (40%) male, 18 (60%) female).

Main outcome measures

Sufficient airway, complications, FEV1, FEV1/FVC, PEF, voice quality VAS, fundamental frequency, jitter, shimmer, NHR, APQ and PPQ scores.

Results

A sufficient laryngeal airway was achieved in all patients. Six patients (20%) developed postoperative granulation tissue (two in group 1 and four in group 2).

There was a statistically significant improvement in FEV1, FEV1/FVC and PEF measurements at the postoperative sixth month compared to preoperative measurements in both of the groups (p<0.05).

Preoperative median voice quality VAS scores in groups 1 and 2 were 8 (IQR=1) and 8 (IQR=3) respectively. Postoperative sixth month voice quality VAS scores in groups 1 and 2 were 6 (IQR=1) and 6 (IQR=0) respectively. Postoperative VAS scores were significantly lower in both groups (p<0.05).

The postoperative changes in fundamental frequency, NHR, jitter, shimmer, APQ and PPQ were not statistically significant in both of the groups (p>0.05).

Conclusions

Laser and diathermy assisted posterior cordotomy are both minimaly invasive, effective techniques with a long-term sufficient laryngeal airway. Despite lower quality of voice VAS scores, objective acoustic outcomes were not significantly lower in both of the groups.

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