Patient Care Voice and Airway

Awake procedure improves visualization, saves patient’s voice

Robert Derousse was diagnosed with thyroid cancer in 2006 and underwent routine treatment. He proudly considers himself a cancer survivor. However, the subsequent loss of his voice led to frustration with both communication and an attempted surgical procedure. An alternative awake procedure by Washington University Chief of Laryngology Molly Huston, MD, would save his voice and his faith in medicine .

It was years later in 2017 that Derousse started to notice a weakness in his voice following prolonged speaking. That weakness progressed to a complete loss of vocal ability, a frustrating situation for Derousse who used his voice constantly to communicate with clients.

A medical evaluation revealed a nodule or polyp growing on one of his vocal cords, a common side effect of the radiation treatment he had received. The decision was made to surgically remove the polyp. When Derousse was anesthetized however, visualization of the vocal cord proved too difficult due to lymphedema  –  swelling due to restricted flow of lymphatic drainage – and a general loss of airway rigidity.

“To say I was disappointed would be an understatement,” said Derousse. “Fortunately, and completely out of the blue, a concerned nurse reached out days later to recommend an alternative procedure offered by Dr. Huston.”

Laryngoscope view of the patient’s vocal folds. The arrow indicates the polyp present on the right vocal cord. The polyp mass impairs vocal cord approximation (closing), which prevents good vocalization.

Awake procedure offers second chance

Huston saw Derousse in clinic and noted a likely hemorrhagic polyp emanating from a radiation-induced telangiectasia, on his right vocal cord. Given the challenging exposure, Huston suggested the best approach was an awake procedure to reduce the polyp using a KTP laser.

“The KTP laser is useful for treating many lesions of the larynx, and the wavelength is selectively absorbed by blood cells, making it particularly useful for vascular lesions like the telangiectasia on our patient’s vocal cord,” said Huston. “It is a relatively quick and painless treatment that most patients tolerate very well.”

Derousse approached the procedure with some hesitation after the previous failed attempt, but Huston’s explanation convinced him to give it a try. Using a flexible laryngoscope, Huston anesthetized his vocal cords. Then, the KTP laser fiber was inserted through the scope and the lesion treated with pulses of energy to reduce its size.

The procedure was a quick one. In fact, Derousse says it took longer to numb the area than to actually treat the polyp. He was in and out of the operating room in 20 minutes.

Life-changing results were almost immediate

The results of laser treatment were apparent almost immediately.  Derousse noted his voice, within just one week, was much stronger. Now, he can talk all week with clients without worry of losing his voice.

Derousse now sees Huston every six months to evaluate the status of the remaining polyp, which he says so far hasn’t changed. If it does, he won’t hesitate to repeat the laser treatment.

If you or someone you know is experiencing a loss of voice or difficulty swallowing, please contact the Voice and Airway Center at Washington University for a comprehensive evaluation.