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UM Voice Experts Among Few in Florida to Offer In-Office Vocal Fold Treatments with ‘Greenlight’ Laser

Laryngologists at the University of Miami Health System are the only voice experts in South Florida to treat vocal cord polyps, recurrent respiratory papillomatosis, precancerous lesions and more using an in-office potassium titanyl phosphate (KTP) laser.

Dr. David Rosow treats a patient with the KTP laser.
Dr. David Rosow treats a patient with the KTP laser.

In-office KTP laser treatment is an alternative to the traditional approach with a carbon dioxide (CO2) laser. Unlike the CO2, KTP laser treatment doesn’t require use of an operating room and sedation. This enables quicker recovery times with less pain, and voice quality outcomes tend to be better, according to David E. Rosow, M.D., director of laryngology and voice at the University of Miami Health System and associate professor of otolaryngology at the Miller School of Medicine.

The CO2 laser can be a harsh tool for treating sensitive vocal folds, Dr. Rosow said.

“For more delicate applications, it’s like bringing a flame thrower to a very delicate operation,” he said.

Harvard dermatologist R. Rox Anderson, M.D., was the first to describe how to use fundamental laser properties to target specific lesions. In the case of vocal folds, the objective is to use a laser energy that’s absorbed by vascular lesions but not by surrounding healthy tissue.

“One of the wavelengths of light that hemoglobin absorbs more effectively than others is at 532 nm, which is the wavelength of light used in the KTP, or greenlight, laser,” Dr. Rosow said. “Dr. Anderson initially applied this idea to vascular lesions on children’s faces, such as port wine stains.”

Like a child’s facial skin, vocal folds have to be treated gently. The vocal fold has to be able to vibrate smoothly and symmetrically in order to generate a good sounding voice.

“The KTP laser allows us to deliver targeted energy at the location of the lesion on the vocal fold, remove it and leave the surrounding tissue relatively intact,” he said.

Dr. Rosow also uses the KTP to treat recurrent respiratory papillomatosis, a condition resulting in benign, vascular wart-like growths on the vocal folds.

“The KTP laser is very effective in treating them,” he said. “Some people have precancerous growths on the vocal folds that need to be removed. The KTP laser can be very effective for that, too.”

There are several important advantages to using the KTP laser versus the CO2 to treat these vocal fold conditions. For example, Dr. Rosow can use the KTP in the office setting because the laser’s energy is delivered with a thin glass fiber.

“We’re able to pass this fiber through a laryngoscope, and I can use the laser on people who are awake and un-sedated in my office in order to remove a variety of lesions,” he said. “The more important issue with the CO2 laser is that for vascular lesions, such as papillomas and polyps, the voice outcome is generally not as good. You have to use relatively more energy with the CO2 laser to remove the vascular lesions. That means more damage to surrounding tissue.”

KTP treatment can be a great option for people who rely on the quality of their voices, including professional singers.

“I’ve treated a lot of singers who have very small, delicate tissues and maybe a very small set of blood vessels that are leaking and causing repeated episodes of bleeding,” he said. “The KTP laser targets those. I like to think of it as the ‘Photoshop effect.’ I can treat the blood vessels with the laser and it’s like erasing them right off the surface.”

The KTP laser has long been used successfully in otolaryngology and dermatology, but there are few places in the state that offer treatment with it in a practice setting.

“The University of Miami Health System is currently the only center in South Florida — even south of Gainesville — offering this technology in an office setting. There are some places where people use it in an operating room. But I think that patients appreciate being able to have their problem treated, then go back to work and their normal day-to-day activities with as little downtime as possible,” Dr. Rosow said.

Patients who complain of hoarseness lasting longer than two or three weeks should be evaluated and their vocal fold examined by an ENT. Other symptoms that could warrant a referral include vocal straining or feeling that the voice is becoming fatigued, difficulty swallowing or feeling a lump sensation in the throat, according to Dr. Rosow.

Tags: Dr. David Rosow, KTP laser, vocal folds