Determination of treatment approach to vocal cord leukoplakia and evaluation ofeffectiveness of proton pump inhibitor treatment

Determination of Treatment Approach to Vocal Cord Leukoplakia and Evaluation of Effectiveness of Proton Pump Inhibitor Treatment Sezen Göktaş S, Determination of Treatment Approach to Vocal Cord Leukoplakia and Evaluation of Effectiveness of Proton Pump Inhibitor Treatment, Bezmialem Vakif University, Medical Faculty Department of Otorhinolaryngology, Thesis for specialty in Medicine, Istanbul, 2016. Objective: The objective of this study is to identify a standardized approach to vocal cord leukoplakia treatment and describe the efficiency of proton pump inhibitor therapy. Study Design: Prospective, Nonrandomized Experimental Clinical Trial Material and Methods: This study included 24 patients with dysphonia who were diagnosed with vocal cord leukoplakia in the Bezmialem Vakif University Ear, Nose and Throat clinic between January 2016 and September 2016. Age, sex, smoking and alcohol intake data have been recorded for all patients. Prior to treatment and at 3rd and 6th months of treatment, each patient was asked to complete the Reflux Symptom Index (RSI) form. In addition, each patient's videostroboscopic examination recordings were evaluated and the RBS (Reflux Symptom Scale) form was completed by the physician. The videostroboscopic video and photographic recordings of the patients were taken and Red-Green-Blue (RGB) measurements were performed in 8 predefined laryngeal regions (epiglottis, right pyriform sinus, left pyriform sinus, right vocal cord, left vocal cord, right arytenoid, left arytenoid and posterior commissure). FIRST EXAMINATION-RISK ASSESSMENT SCALE was applied to the patient, which is related to the risk of laryngeal carcinoma. Accordingly, patients with a risk score of 13 or more were excluded from the study and were directed to microlaryngeal surgery for biopsy in our clinic. Patients with a score below 13 were included in the study. All of the patients were treated with PPI twice a day for the first 3 months. Dietary and lifestyle changes were suggested. After three months, patients were re-evaluated with videostorboscopic examination, RSI, RFS and RGB measurements. Patients were divided into 2 groups according to the rate of regression of the lesion at the end of the 3rd month. 3RD MONTH LESION ASSESMENT SCALE was used for this evaluation. After this scoring, patients with a score of 8 or less were included in Group 1 (n=19) and PPI treatment was continued for 3 months for 2 times per day. Patients with a score of more than 8 were included in Group 2 (n = 5) and all were treated with microlaryngeal surgery by the same method and by the same surgeon. The pathology results of all the patients' were benign. For prevention of recurrence, proton pump inhibitor treatment was continued for 2 doses per a day for three months. At the 6th month control, the RSI form was filled in by the patients, and the RGB and RFS values were calculated using videostroboscopic records. Pre-treatment, 3rd month and 6th month values of the patients were compared. Results: The ages of the patients ranged from 35 to 79, with a mean age of 58.75. Sixty years and younger patients (n = 14) were 58.3% of the total and over 60 years patients (n = 10) were 41.7%, 20.8% (n = 5) of the patients were female and 79.2% (n = 19) were male. The patients were divided into four groups which are related to their smoking habits; Group 1: nonsmoker (n=9, 37.5%), Group 2: 0 -10 pack/year smoker (n=6, 25%), Group 3: 11-20 pack/year smoker (n=5, 20.8%), Group 4: over 21 pack/year smoker (n=4, 16.7%). Four patients (16.7%) consumed alcohol. The patients were compared with their RSI and RBS values obtained at the first examination, 3rd and 6th months. A significant decrease was observed between the first examination and the 3rd month examination and the first examination and the 6th month examination. When comparing the RGB values of the first examination and the 3rd and 6th month examination larynx photographs, there was no significant difference between the GREEN and BLUE values. However, the RED values of all laryngeal regions were significantly decreased between the pretreatment and the sixth month of treatment examination recordings. At the end of 6th month, when all patient's results assessed, , 29,2% of patients (n=7) showed complete regression of lesions, 50%of patients (n=12) showed partial regression of lesion and 20,8% of patients (n=5) showed no response to treatment. Conclusion: Surgical and non-surgical treatment options are available for vocal cord leukoplakia treatment. When the treatment approach is determined, it can be decided by using the assessment table which is derived from characteristics of the patient and the lesion. Thus, a standard approach to vocal cord leukoplakia treatment can be established. In this study, we prepared a standard treatment approach to vocal cord leukoplakia. In addition, in our study, proton pump inhibitor treatment was effective in reducing lesion and preventing recurrence after surgery in patients with vocal cord leukoplakia. Proton pump inhibitors can be used in the non-surgical treatment of patients with vocal cord leukoplakia successfully. Key words: Vocal cord leukoplakia; proton pump inhibitor; laryngopharyngeal reflux; dysphonia