Work

Phonosurgical Treatment of Laryngeal Leukoplakia and Dysplasia: Results of Multidimensional Voice Diagnostics Including the VEM

Year: 2026

Type: article

Abstract: Background/Objectives: Laryngeal leukoplakia and dysplasia carry a variable risk of malignant transformation. Although microlaryngoscopic excision is standard of care, data on voice function are limited. Multidimensional diagnostics, including the Vocal Extent Measure (VEM), were employed to assess pre- and postoperative status while identifying factors associated with vocal outcomes. Methods: This retrospective cohort included 44 patients with histologically confirmed vocal fold leukoplakia or dysplasia. All underwent cold steel or laser-assisted phonomicrosurgery. Voice assessments were conducted pre- and three months postoperatively, comprising videolaryngostroboscopy, auditory-perceptual evaluation of grade, roughness and breathiness (GRB), self-assessment (Voice Handicap Index, VHI-9i), and objective acoustic-aerodynamic measures. Results: Overall, 57% of patients were active smokers; 73% consumed alcohol. Lesions were mostly unilateral (77%), craniomedially localized (65%), and involved up to one-third of the vocal fold (48%), with impaired mucosal wave (76%). Histopathology revealed mainly hyperkeratosis (52%) and dysplasia (35%). Recurrence rate was 14%, with histology unchanged. Postoperatively, subjective measures showed significant improvements (post- vs. preoperative), with decreased VHI-9i scores (10 vs. 14) and GRB ratings (p < 0.05). Objective measures showed positive trends, including enhanced vocal capacity (VEM 85 vs. 82), stability (jitter 0.6 vs. 0.8%), and aerodynamics (maximum phonation time 18 vs. 15 s). Phonosurgical method, histopathology, and age did not significantly affect voice outcomes; however, higher dysplasia grades and younger age showed trends toward greater VEM gains. Conclusions: Phonomicrosurgical excision of laryngeal leukoplakia and dysplasia effectively preserves or enhances vocal function. The VEM provides a reliable, quantitative complement to established voice diagnostics and should be integrated into standardized assessment protocols.

Source: Diagnostics

DOI: 10.3390/diagnostics16081242