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Sir,
Matar et al. [1] nicely presented their results after CO2 laser-assisted microsurgery for intracordal cysts. The use of the laser in their clinic is widely acknowledged, recognized and respected. However, caution should be taken as one might think that laser-assisted microsurgery is the single best technique in treating intracordal cysts. As no comparison is made with the standard cold steel microsurgery, this is a question that remains unanswered.
We have published VHI results of patients with benign voice disorders [2], including cold steel microsurgery of intracordal cysts. Interestingly enough, the subjective functional results are very comparable. In our series of 68 patients, 8 were treated for intracordal cysts, 2 males and 6 females. Their VHI changed from 44/120 preoperatively to 25/120 3 months postoperatively, where Matar et al. describe 51/120 and 28/120, respectively.
Some comments should be made. Results are presented quite roughly: the change in median G in the GRBAS has been presented without mentioning the mean G. Improvement and trends were mentioned in changes of R, S, and B scale without offering exact data. Change in mean frequency range was presented in Hz, while dealing with a population of a combination of males and females. As the Hz scale is a logarithmic one, it would have been better to present the change in frequency range in semitones, thereby abolishing gender differences.
The authors should be congratulated with the nice description of the surgical technique. However, laser-assisted microsurgery is more expensive [3]. Laser-assisted microsurgery for intracordal cysts offers no clinical advantages. Comparable functional results can be obtained using cold steel instruments. In conclusion, laser-assisted microsurgery for intracordal cysts decreases cost-effectiveness.
References
Matar N, Amoussa K, Verduyckt I, Nollevaux MC, Jamart J, Lawson G, Remacle M (2010) CO2 laser-assisted microsurgery for intracordal cysts: technique and results of 49 patients. Eur Arch Otorhinolaryngol 267:1905–1909
Bouwers F, Dikkers FG (2009) A retrospective study concerning the psychosocial impact of voice disorders: voice handicap index change in patients with benign voice disorders after treatment (measured with the Dutch version of the VHI). J Voice 23:218–224
Benninger MS (2009) Laser surgery for nodules and other benign laryngeal lesions. Curr Opin Otolaryngol Head Neck Surg 17:440–444
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Open Access This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License (https://creativecommons.org/licenses/by-nc/2.0), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
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Dikkers, F.G. Laser-assisted microsurgery for intracordal cysts decreases cost-effectiveness. Eur Arch Otorhinolaryngol 268, 755 (2011). https://doi.org/10.1007/s00405-011-1531-0
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DOI: https://doi.org/10.1007/s00405-011-1531-0