The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus

OBJECTIVE

The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR.

METHODS

Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician.

RESULTS

After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h.

CONCLUSION

A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR.

LEVEL OF EVIDENCE

5 Laryngoscope, 134:1614-1624, 2024.

Local inflammatory marker production in Lithuanian patients with chronic rhinosinusitis with nasal polyps

There are two clinical subtypes of chronic rhinosinusitis (CRS): chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). The aim of the study here was to determine the levels of invasive inflammatory markers in nasal mucosa samples taken from CRSwNP patients during the surgery and to identify markers that could serve as targets for potential clinical and therapeutic interventions. The study was carried out in 59 patients with proven CRSwNP and a control group consisting of 52 healthy individuals. Concentrations of the inflammatory markers of interest were determined using a LuminexR Assay multiplex kit. The data obtained indicated that levels of inflammatory cytokines interleukin (IL)-2, -4, -5, -7, -12, -17 and -22 were all significantly higher in the nasal polyps (NP) than those in the mucosa of control participants. No differences were seen between the study groups for IL -6, -10, -13, -21 and interferon (IFN)-γ. OR (Odds Ratio) analyses confirmed that elevations in mucosal levels of IL-2, -4, -5, -7, -12, -17, and -22 were likely immune markers of CRSwNP. In conclusion, the present study demonstrated that IL-2, -4, -12 and -22 may be important in the etiopathogenesis of CRSwNP; as markers, each show moderate sensitivity, but high specificity in the Lithuanian population. IL-17 had good sensitivity, but low specificity in the CRSwNP patients.

Frozen versus fresh reconstituted botox for laryngeal dystonia

Objectives

To compare the efficacy and side effects of frozen versus fresh reconstituted botulinum toxin type A (BTX-A) in the treatment of laryngeal dystonia.

Study Design and Setting

Prospective open-label crossover study; 43 adult patients with adductor spasmodic dysphonia were randomly treated with fresh or refrozen reconstituted BTX-A at a private voice center. Treatment outcomes were assessed by duration of action and self-rated satisfaction (7 point Likert scale). Side effects of breathiness and dysphagia for liquids were assessed as well.

Results

There was no statistically significant difference in the duration of action (mean, 16.2 ± 8.5 vs 16.0 ± 7.6 weeks) and self-rated satisfaction of the treatment (median, 6.0 vs 6.0 points). The side effects were similar for both BTX-A injection types. In addition, there were no instances of infection for refrozen injections.

Conclusions

BTX-A may be safely used after being reconstituted and frozen or refrozen without a significant loss of effectiveness or additional side effects. In our experience, the period of freezing was on 2 occasions for up to 8 weeks.

Significance

Refrozen BTX-A may be a cost-effective use of an expensive drug. EBM rating: B-2b

Efficacy of sucralfate for the treatment of post-tonsillectomy symptoms

Pain after tonsillectomy remains the main issue of postoperative morbidity and the search for an effective post-tonsillectomy analgesic is of increasing relevance. The aim of this study was to evaluate the effectiveness of topical sucralfate during an early post-tonsillectomy period. Fifty patients of both genders from 6 to 58 years submitted to tonsillectomy or adenotonsillectomy were randomly included into either a sucralfate treatment group (N = 25) or into a control group (N = 25). Patients of the sucralfate group received topical sucralfate four times a day for 7 days. No topical treatment was applied to patients of the control group. A systemic analgesic was standardized. Post-tonsillectomy symptoms, including throat pain, odynophagia and otalgia, were evaluated during the period of seven postoperative days. Secondary outcomes were analgesic use, well being in general, return to regular daily activities, secondary hemorrhage and side effects of sucralfate. This study revealed that during the period of the second to seventh postoperative days average throat pain scores of the sucralfate using patients were significantly lower than those of the control group patients (p < 0.05); the same could be applied to odynophagia scores during the period of all seven postoperative days (p < 0.01) and otalgia scores from the 4th postoperative day (p < 0.05). The sucralfate group patients also had a significantly smaller need for analgesics, better scores of well being in general and early return to regular daily activities with no side effects of the treatment. Topical sucralfate could be recommended for the everyday clinical practice as a safe, adjuvant medicine of treatment during the period of the first post-tonsillectomy week.

Indications and Safety of Up-to-Date Lingual Tonsillectomy

Objectives:

To describe the main indications for lingual tonsillectomy (LT) and to analyze the safety and post-operative morbidity of LT with laryngoscopic approach.

Methods:

In this prospective observational study, 70 consecutive adult patients (31 males and 39 females) with hypertrophic lingual tonsils proven by fibronasolaryngoscopy during April 2009 to December 2012 operated at a university hospital were selected. LT was performed under general anesthesia and direct micropharyngoscopy with laryngeal microinstruments and electrocoagulator. Indications for operation, procedure time, intraoperative blood loss, post-operative pain measured using 100-mm visual analogue scale (0– no pain, 100– extreme pain), complications (post-operative bleeding, edema of epiglottis and infection), and length of stay in the hospital were assessed.

Results:

Dysphagia in relation to laryngopharyngeal reflux (55.7% of cases) and sleep-disordered breathing (38.6% of cases) were the main indications for LT. Mean procedure time was 41.1+/- 10.2 min. with an average intraoperative blood loss of 21.9+/- 11.1 ml. Post-operative pain score for the first two days was mild and ranged from 0 to 51 points (mean 27.8+/- 9.8 points). There was no post-operative bleeding. Three patients (4.3%) had slight edema of epiglottis. Mean discharge time was 2.4 days. Post-operative pain was positively moderately related to procedure time, amount of intraoperative blood loss, and degree of lingual tonsil hypertrophy (p<0.01).

Conclusions:

Lingual tonsillectomy using laryngoscopic approach is a safe method with minimal post-operative morbidity and could be routinely used in clinical practice.

Speech Range Profile for Moderate-to-Severe Hearing Impaired Persons

Objectives:

Analyze the differences between speech range profile (SRP) parameters in moderate-to-severe hearing impaired and well-hearing persons and to establish the key parameters for speech discrimination.

Methods:

Data were analyzed in a retrospective study of SRPs in combination with voice range profiles (VRP) recorded at a university hospital during 2001-2004.Standard protocols were derived from 80 adult patients (26 males, 54 females) with moderate-to-severe hearing loss without hearing-aids or laryngeal pathology. Ninety-eight non-hearing impaired age and gender matched persons (33 males, 65 females) with normal voices were also analyzed. Eight SRP parameters were assessed: fundamental frequency (F0), maximum speaking frequency and speaking tone range; habitual intensity, maximum speaking intensity and speaking intensity range; location of F0 within VRP pitch range, and slope of speaking curve.

Results:

When compared to -normal hearing persons, both genders of hearing impaired individuals exhibited significantly decreased mean values of speaking intensity range and increased in percent of location of F0 within the VRP pitch range ( P < 0.05). Overall discrimination accuracy of these two SRP key parameters was 93.3%.

Conclusions.

Moderate-to-severe hearing impaired persons demonstrated restricted speaking capabilities in comparison to non-hearing impaired persons. Key parameters of speech range profile may be useful for assessment of hearing and speech rehabilitation efficacy.

Helicobacter pylori infection in laryngeal diseases

Clinical studies have shown that Helicobacter pylori can be found not only in the mucosa of the stomach, but in the pharyngeal and laryngeal regions as well. The aim of this prospective case-control study was to identify H. pylori infection in the biopsy material from the larynx of the patients suffering from benign laryngeal diseases (vocal fold polyps, laryngitis) and laryngeal cancer and to investigate the possible relationships between the laryngeal H. pylori and patients' socio-demographic data and laryngopharyngeal reflux. The results of the biopsy material from 67 adult patients treated for benign laryngeal diseases and laryngeal cancer and 11 individuals of the control group revealed that H. pylori infection could be identified in more than one-third of the patients. In the majority of cases H. pylori was found in the patients with chronic laryngitis (45.5%) and laryngeal cancer (46.2%). The findings of these sub-groups significantly differed from those of the control group (9.1%) (p < 0.05). No significant relationships between H. pylori infection found in the laryngeal region and patients' demographic data, their unhealthy habits and reflux-related symptoms or signs were obtained. It could be concluded that H. pylori can colonize in the larynx of patients with benign laryngeal diseases and laryngeal cancer. To clarify the role of H. pylori as a risk factor for laryngeal diseases further research is needed.

Usefulness of assessment of voice capabilities in female patients with reflux-related dysphonia

OBJECTIVES

To analyze vocal capabilities in patients diagnosed with reflux related dysphonia versus controls with healthy voice with selection of the most informative discriminating quantitative parameters and to assess voice changes following treatment.

MATERIAL AND METHODS

Six parameters of voice range profile (VRP) and five parameters of speech range profile were taken and analyzed from 60 dysphonic outpatient females with laryngopharyngeal reflux (LPR) diagnosed by reflux-related atypical and typical symptoms, videolaryngoscopic findings, upper gastrointestinal endoscopy, and positive response to empiric 3-month omeprazole treatment. Seventy-six females with healthy voice served as controls.

RESULTS

All six parameters of voice range profile and three of 5 parameters of speech range profile showed significant differences comparing LPR patients with controls before omeprazole treatment (P<0.05). Logistic regression analysis revealed VRP maximum-minimum intensity range to be the most informative parameter for discrimination between reflux-related dysphonic and healthy voices (overall prediction accuracy, 86.8%). A threshold value of significant parameter was stated using the receiver operating characteristic curve. Treatment with omeprazole significantly improved voice quality showing the greatest changes in the mean scores of majority of voice range profile parameters.

CONCLUSIONS

Vocal capabilities, especially evaluated by voice range profile, are restricted in LPR female patients in comparison to subjects with healthy voice. Quantitative voice assessment with voice range profile may add more objective aspect for screening dysphonia and could be used as a criterion of evaluation of treatment efficacy in such patients.

Quality of life and voice in patients treated for early laryngeal cancer

OBJECTIVES

To evaluate quality of life and voice in patients previously treated for early laryngeal cancer versus healthy controls and to assess correlations between demographic and cancer characteristics and posttreatment quality of life and voice.

MATERIAL AND METHODS

A total of 49 patients diagnosed with early (Tis-T2N0) laryngeal carcinoma, treated by radiotherapy or endoscopic surgery at least 6 months before, who were alive and free of recurrence formed study group. Postservice with questionnaires was accomplished. Quality of life was evaluated using Medical Outcomes Study 36-Item Health Survey (SF-36), Hospital Anxiety and Depression (HAD) Scale, voice quality--by Voice Handicap Index (VHI). Normative data were obtained from database or concurrently assessed healthy adult subjects.

RESULTS

Hoarseness was the most frequent complain. Majority of patients consider their health as fair (69.4%), one third--good or excellent. The means of summary of SF-36 scores for physical and mental health differ significantly from normative age-matched population (P<0.001). Emotional distress on HAD scale was found in 40.8% of patients vs. 17.0% of healthy controls. Majority (87.8%) of patients rated their voice abnormal; vast majority of them had slight to moderate dysfunction. Mean VHI scores were slight elevated for patients and differed significantly from healthy ones. Correlation analysis revealed a significant relationship between patients' physical health and some demographic-clinic factors.

CONCLUSIONS

Quality of life in patients previously treated for early laryngeal cancer was worse than healthy subjects. Psychiatric morbidity was indicated in around of one-third of the patients. Voice changes were reported in most patients with low handicap level. Physical health perception was better for patients with higher grade of cancer differentiation, not using alcohol, and treated first.

Quality of Life in Laryngopharyngeal Reflux Patients

OBJECTIVES

To evaluate and compare quality of life (QL) parameters in patients with laryngopharyngeal reflux (LPR) versus healthy controls, to determine the impact of clinical signs to QL, and to assess changes in QL parameters after treatment.

STUDY DESIGN

Prospective, open, clinical study.

MATERIAL AND METHODS

One hundred outpatients with LPR and 109 healthy voice controls were enrolled. LPR patients underwent endoscopy and received omeprazole for 3 months. Results of endoscopy revealed 79 patients without esophagitis and 21 with, giving two subgroups of LPR patients. QL was evaluated using voice handicap index (VHI), hospital anxiety and depression scale, disability in social activities, and well-being in general (W-BVAS).

RESULTS

The mean scores for total VHI and functional, physical, and emotional functioning domain subscales were found to be significantly higher in LPR patients versus controls (P < .0001), with no difference among LPR subgroups. Abnormal anxiety was one third in both LPR subgroups versus 6.4% of controls (P < .001). Both LPR subgroups patients had significantly reduced social activities and significantly lower mean W-BVAS score than controls. LPR symptoms had a significant relation with all tested QL parameters, whereas laryngoscopic findings had a significant relation with VHI and W-BVAS only. All mean QL parameters scores improved after 3-month omeprazole treatment.

CONCLUSIONS

QL in LPR patients with or without esophagitis is impaired significantly in many aspects. Impairment of QL is more associated with symptoms than laryngoscopic findings. Treatment with omeprazole significantly improved QL in both LPR subgroups patients.

[Modern attitude towards management of laryngopharyngeal form of gastroesophageal reflux disease. Lithuanian clinical practice guidelines for adults]

The aim of this article is to introduce Lithuanian clinical practice guidelines for the management of laryngopharyngeal form of gastroesophageal reflux disease for standardization of the diagnosis and treatment of the disease and prevention of its complications. Composed guidelines provide recommendations for primary care physicians as well as otorhinolaryngologists and gastroenterologists for the management of adults with uncomplicated laryngopharyngeal form of gastroesophageal reflux disease. Committee composed of experts from Lithuanian Otorhinolaryngological and Gastroenterological Societies developed guidelines based on a comprehensive review of the evidence-based literature related to laryngopharyngeal form of gastroesophageal reflux disease and guidelines of other countries. The guidelines provide description of each medicine groups with emphasis on proton pump inhibitors as the most effective drugs for the treatment of laryngopharyngeal form of gastroesophageal reflux disease. Indications for empirical treatment with proton pump inhibitors are described, as well as duration of treatment, doses, optimal regimen of use, and assessment of treatment efficacy. The therapy should begin with the application of proton pump inhibitors twice daily, before meal for three months. Combined therapy for nonresponders is described. Algorithm for stopping the medication is recommended. These recommendations may provide an efficient and economical approach to the management of this problem.

[Diagnostics of laryngopharyngeal form of gastroesophageal reflux disease for adults (Lithuanian clinical practice guidelines)]

The laryngopharyngeal form of gastroesophageal disease represents one of the atypical manifestations of supraesophageal gastroesophageal reflux disease characterized by morphologic and functional changes in the larynx and pharynx with the associated clinical symptoms. The article presents diagnostic algorithm (guidelines) for laryngopharyngeal form of gastroesophageal disease, elaborated by the group of Lithuanian experts in otorhinolaryngology and gastroenterology. The guidelines are based on the data of evidence-based medicine and results of the scientific studies in Lithuania. Diagnostics of laryngopharyngeal form of gastroesophageal disease has to be based on: (1) patient's complaints (permanent hoarseness, throat itching and clearing, cough, heartburn, "globus" sensation) for more than 3 months; (2) typical laryngoscopic findings (edema, erythema, roughness, hypertrophy of mucosa of the posterior glottis); (3) detection of reflux esophagitis as a subsequence of pathological gastroesophageal reflux; (4) assessment of relationship between reflux and morphological/functional changes. The guidelines are designed for the otorhinolaryngologists, gastroenterologists, and general practitioners.

Thyroid Surgery: Changing Patterns of Practice

OBJECTIVE

The practice of thyroidectomy has evolved over the past 10 years with the introduction of minimally invasive surgery, laryngeal nerve monitoring, and outpatient surgery. We sought to investigate corresponding trends in the disciplines performing thyroid surgery.

METHODS AND MATERIALS

The authors conducted a nonrandomized, case-controlled comparison of surgical volumes and systematic analysis of publication volumes. Two surrogates for the proportion of thyroidectomies being performed by otolaryngologists-head and neck surgeons (OHNS) and general surgeons (GS) were chosen: 1) the operative case logs of graduates from American training programs in OHNS and GS from 1995 through 2004 were compared; and 2) the number of scientific articles published relating to thyroid surgery were systematically queried for two timeframes (1990-1994 and 2000-2004).

RESULTS

There was a gradual increase in the mean number of thyroidectomies performed by GS residents from 13.2 in 1995 to 18.2 in 2004. During the same timeframe, the mean number of thyroidectomies performed by OHNS residents more than doubled from 15.0 to 33.5. The number of American GS thyroid publications from 1990 to 1994 was 79, compared with 98 in the period 2000 to 2004, representing a 24% increase. During the same timeframe, the number of American OHNS articles increased from 14 to 49 (a 250% increase). The relative proportion of thyroid publications authored by American otolaryngologists more than doubled from 15.1% to 33.3% (P = .0017).

CONCLUSIONS

A clear trend is emerging in the pattern of thyroid surgery in that a growing proportion of publications are being authored by otolaryngologists compared with general surgeons, and the average number of procedures performed by graduating chief residents is now 84% higher in otolaryngology compared with general surgery.

Quantitative analysis of professionally trained versus untrained voices

The aim of this study was to compare healthy trained and untrained voices as well as healthy and dysphonic trained voices in adults using combined voice range profile and aerodynamic tests, to define the normal range limiting values of quantitative voice parameters and to select the most informative quantitative voice parameters for separation between healthy and dysphonic trained voices. Three groups of persons were evaluated. One hundred eighty six healthy volunteers were divided into two groups according to voice training: non-professional speakers group consisted of 106 untrained voices persons (36 males and 70 females) and professional speakers group--of 80 trained voices persons (21 males and 59 females). Clinical group consisted of 103 dysphonic professional speakers (23 males and 80 females) with various voice disorders. Eighteen quantitative voice parameters from combined voice range profile (VRP) test were analyzed: 8 of voice range profile, 8 of speaking voice, overall vocal dysfunction degree and coefficient of sound, and aerodynamic maximum phonation time. Analysis showed that healthy professional speakers demonstrated expanded vocal abilities in comparison to healthy non-professional speakers. Quantitative voice range profile parameters- pitch range, high frequency limit, area of high frequencies and coefficient of sound differed significantly between healthy professional and non-professional voices, and were more informative than speaking voice or aerodynamic parameters in showing the voice training. Logistic stepwise regression revealed that VRP area in high frequencies was sufficient to discriminate between healthy and dysphonic professional speakers for male subjects (overall discrimination accuracy--81.8%) and combination of three quantitative parameters (VRP high frequency limit, maximum voice intensity and slope of speaking curve) for female subjects (overall model discrimination accuracy--75.4%). We concluded that quantitative voice assessment with selected parameters might be useful for evaluation of voice education for healthy professional speakers as well as for detection of vocal dysfunction and evaluation of rehabilitation effect in dysphonic professionals.

Diagnostic test with omeprazole in patients with posterior laryngitis

The aim of the study was to evaluate the merit of empiric omeprazole therapy in patients with suspected laryngopharyngeal reflux (LPR), to determine the optimal dose and duration of diagnostic test, to compare the diagnostic value of upper gastrointestinal (GI) endoscopy and omeprazole test (OT). One hundred out-patients with posterior laryngitis and more than one atypical symptom of LPR, aged 14-68 years were treated with omeprazole for 4 weeks (clinical group). According to received omeprazole dose (20 mg, 40 mg, > 40 mg), three clinical subgroups were selected. Twenty patients treated only with life style modifications and diet composed dietary group. At the entry to the study, a symptom questionnaire (5 laryngeal and 3 esophageal scored from 0 to 3 points), well being in general (W-B(VAS) on 100-mm VAS scale), videolaryngoscopy, upper endoscopy, and voice assessment (4 voice range profile parameters and overall vocal dysfunction degree (VDD)) were completed. Total symptom index (TSI) was calculated multiplying sum of symptoms severity score by number of presented symptoms. Normal values of efficacy parameters were obtained from 113 healthy voice subjects (control group). Patients were evaluated twice during the treatment: after 1-2 weeks and after 4-5 weeks. Patients were confirmed as responders, if TSI improved at least 50%, and patients were satisfied with results. According to our data, the 1st control assessment showed significant improvement on symptoms, laryngoscopy scores, VDD, and W-B(VAS) only for clinical group patients (p<0.05). Responders rate also was advantageous for the clinical group patients in comparison to the dietary group (36.0% vs. 15%). The second control assessment showed significantly better results for the clinical group patients in comparison to the 1st (p<0.05 2nd vs. the 1st). Sixty five percent of them (65/100) were classified as responders (p<0.05). The better results were in patients receiving omeprazole more than 20 mg daily. Erosive esophagitis during upper GI endoscopy was found for 21.0% (21/100) clinical group patients, 18 of them were responders to omeprazole 4-week test (accuracy of OT with regard to confirmed diagnosis with upper endoscopy was 85.7%). At week 4, efficacy parameters were not in normal range. We concluded that short-term treatment with omeprazole might be useful in confirming the clinically based diagnosis of laryngopharyngeal reflux.

[Importance of voice quality evaluation in the assessment of treatment outcome after endolaryngeal microsurgery]

The aim of the study was to compare subjective and quantitative voice characteristics changes after endolaryngeal microsurgery with respect to different postoperative follow-up term. We evaluated 80 surgically-treated patients aged 14-81 years (mean 42.6+/-13.8 years) with benign vocal cord (VC) lesions (polyps, n=37; cysts, n=16; Reinke's edema, n=18; papilomata, n=9). Patients were evaluated three times - before operation, less than two weeks (mean 1.0+/-0.4) following the operation and more than two weeks (mean 6.5+/-3.9) following the operation. Control group consisted of 122 healthy voice patients. Subjective voice evaluation composed of experts assessment (GRBAS hoarseness scale, visual analogue scale (VAS) of voice quality) and patients self-evaluation (VAS, voice handicap index, and the impression of what repercussions the voice problem has on professional life and emotions). Seven quantitative voice parameters obtained from voice range profile, laryngostroboscopy and registering of maximum phonation time were analyzed as well as overall vocal dysfunction degree (VDD). The data of second postoperative examination were statistically significantly better compared to the first postoperative follow-up (p<0.001). During the first postoperative examination the subjectively healthy voice (G=0) was found for 13.8% (11), quantitatively (VDD=0) for 22.5% (18) of patients, during the second - 63.8% (51) and 53.8% (43). The best results were for patients with vocal cords polyps. The complex voice assessment may be useful for evaluation of voice function recovery and efficacy of surgical treatment.

[Phonatory characteristics following different endolaryngeal microsurgical techniques in Reinke's disease]

The aim of the study was to compare different surgical techniques in treatment of Reinke's edema according to subjective and quantitative changes of voice characteristics. We evaluated 62 surgically treated patients from 34 to 68 years (mean 47.7 years) with Reinke's edema. Two endolaryngeal microsurgical methods were used: classical as mechanical stripping of the mucosa-Ist, mechanical stripping group (n = 30), and removal of fluid through aspiration with preservation of vocal cord medial edges mucosa-IInd, preserving mucosa group (n = 32). Clinical voice assessment was composed of laryngoscopy, subjective voice evaluation (GRBAS hoarseness scale, visual analogue scale of voice quality, and pitch) and quantitative voice evaluation (seven quantitative voice parameters obtained from voice range profile (VRP) and registering of maximum phonation time). Patients were evaluated twice--before operation and at mean 23.8 days after. Postoperative follow-up data was registered from 57 patients: 28 from Ist and 29 from IInd groups. According to our data the positive dynamics for all voice parameters was observed in both patients' groups. Surgical approach with preservation of vocal cord medial edges mucosa on overall benefit after operation according to the voice quality is statistically significantly better compared to classical operation technique (chi 2 = 8.9, p = 0.029). While comparing these two approaches statistically significant differences were found for subjective voice parameters--grades of hoarseness and roughness, and for quantitative VRP parameters: pitch range, maximum-minimum intensity range, total voice area, and overall vocal dysfunction degree. The mean values of most voice parameters in early postsurgery period significantly differed from normal. Clinical voice assessment may be useful for evaluation of surgical treatment efficacy as well as for comparison of surgical techniques.