Dysplasia usually occurs diffusely in the larynx and frequently recurs, said Dr. Johns. Consequently, otolaryngologists will need to perform frequent biopsies and follow these with serial endoscopies. With photoangiolytic laser treatments, patients can undergo multiple treatments without general anesthesia and no significant health risk, he explained. Moreover, targeting the lesion’s vascular supply with the laser allows the physician to treat more tissue than with a resection, added Dr. Johns.
Papillomatosis is a recurrent problem for which the traditional approach was direct laryngoscopy and excision in the operating room, continued Dr. Johns. We’d have to wait until the disease was advanced, which could cause large fluctuations in the patient’s voice and quality of life, he said. With lasers, physicians can treat the disease more frequently to keep it at bay and limit wide voice fluctuations, he explained.
Although physicians used to put patients under general anesthesia in the operating room for these conditions, now we treat in them in the office under local anesthesia in 20 to 30 minutes, said Dr. Zeitels, who, with his colleagues, performed the first office-based laser procedure to treat laryngeal disease in the fall of 2001 using a pulsed-dye laser (PDL). Dr. Zeitels has received free lasers on which to conduct research, but has not accepted funding from manufacturers.