Pulsed-dye laser surgery for voice disorders better all round

The newly developed pulsed-dye laser surgery for voice disorders has been found to be faster, cheaper, better tolerated, and less complicated than standard surgery that requires general anesthesia, more time and a longer recovery, surgeons reported here today at an international conference on problems associated with laryngopharyngeal reflux.

“This is the way a lot of surgery will be done in the future in other areas you can reach with an instrument from the outside,” said Jamie Koufman, M.D., the director of the Center for Voice and Swallowing Disorders and Wake Forest University Baptist Medical Center. “We are already using it in the trachea and upper lung. We are looking at other applications as well.”

Pulsed-dye lasers (PDLs) were originally developed to treat skin conditions, such as birthmarks, that involve blood vessels. Pulsed-dye refers to the material used to generate the laser beam.

Koufman said that the PDL is what you might call a “smart” laser – it gets rid of the bad while preserving the good, particularly in the voice box. She made the presentation about the new method of throat surgery and its delivery system – the transnasal esophagoscope – at a conference on “Laryngopharyngeal Reflux, Dysphagia and Laryngology,” cosponsored by the Voice Center and the American Broncho-Esophagological Association.

After the patient’s throat is sprayed with numbing medication, a tube the width of a drinking straw, goes down the nose and into the throat or voice box. Surgeons place the laser fiber through this flexible scope. The laser fires at and destroys abnormal tissue while ignoring healthy tissue.

“You numb the larynx, the patient coughs and spreads the medicine down the throat, and minutes later, it‘s over,” Koufman said.

Gregory N. Postma, M.D., a laryngologist at Wake Forest Baptist, said that when he gives his patients a choice of using the PDL method versus standard surgery, nearly everyone chooses in-office PDL.

PDL is used most frequently to get rid of recurrent papillomas (laryngeal warts) and bumps on the vocal folds, Postma said. “The possibilities are endless – this is the future of a lot of larynx and windpipe surgery.”

Wake Forest Baptist and Harvard University have been the pioneers in this technology, using lasers donated by Cynosure Corp., Koufman said.

Through presentations and hands-on workshops, the conference will address larynopharyngeal reflux (LPR) and its relationship to swallowing and voice disorders. The term “reflux” is most often referred to gastroesophageal reflux disease (GERD). However, LPR, which is the backflow of gastric juices into the larynx and throat, is also damaging but less recognized and understood. Symptoms include chronic, intermittent or “morning” hoarseness, sore throat, dysphasia (difficulty swallowing), chronic throat clearing, globus (a sensation of a lump in the throat) cough, wheezing and halitosis.

Other presentations at the conference will cover the difference between LPR and GERD, laryngeal and pulmonary manifestations of LPR, diagnostic techniques and new technology.

Faculty for the international conference includes noted experts from Wake Forest Baptist and others from throughout Europe and the United States. Besides Koufman and Postma the other two course directors are Peter Dettmar, PhD, adjunct research professor at the Voice Center, and Julian McGlashan, MD, of University Hospital, Queens Medical Centre, Nottingham, England. http://www.wfubmc.edu/