Patient Tolerance of the Flexible CO2 Laser for Office-based Laryngeal Surgery

Objective. The OmniGuide flexible carbon dioxide (CO2) laser can be readily used in the office but patient tolerance has not been established. The aim of this pilot study was to determine patient tolerance of the flexible CO2 laser. As a reference point, the 585-nm pulsed-dye laser (PDL) was selected for comparison because it is the only office-based laser in which patient tolerance has specifically been studied. Methods. Prospective pilot study involving office-based surgery candidates with benign laryngeal pathology. Via flexible laryngoscopy, half of each lesion was treated with the CO2 laser and the remaining half with the PDL, alternating the order of the lasers (to account for potential thermal injury from the first laser) and blinding the patient to treatment. Patients rated their discomfort immediately after each laser treatment and then completed postoperative questionnaires for discomfort and voice quality. Results. Ten patients with benign laryngeal disease were included. All patients tolerated the office-based laser surgeries without difficulty. The CO2 laser was extremely well tolerated, with mean pain and burning scores of 2.0 and 2.3, respectively, on a scale of 1-10 (10 being intolerable pain). Postoperative pain questionnaires demonstrated minimal discomfort after the laser treatment. Those with resolution of laryngeal disease had significant voice improvement. Conclusion. Flexible CO2 laser laryngeal surgery is well tolerated in an office-based setting.