Glowing vocal cord undergoing laser treatment for cancer.

Preserving Your Voice: A Comprehensive Guide to Glottic Tumor Treatment

Theo Raines in Health & Wellness November 2025 • 3 min read.

"Discover the latest advancements in voice preservation for early glottic cancer, comparing laser surgery and radiotherapy."

When facing early glottic cancer, preserving your voice is often as important as fighting the disease itself. Transoral CO2 laser cordectomy, a type of laser microsurgery (TLM), has become a popular treatment, offering advantages like being a single-session procedure with minimal hospitalization and reduced morbidity. It stands alongside radiotherapy (RT) as a primary treatment option, both aiming for high cure rates.

For years, there's been a debate about whether TLM or RT provides better voice quality outcomes. Early TLM techniques, using larger, less precise instruments, sometimes resulted in more tissue damage, leading to the perception that radiation therapy was superior for voice preservation. However, with technological advancements, modern TLM now utilizes precise micromanipulators and scanner technology, significantly reducing tissue damage and allowing for more functional resections.

Today, surgeons can achieve complete tumor removal while preserving more of the vocal cords, leading to improved voice outcomes. This has reignited the conversation, making it crucial to understand how these treatments compare and what to expect.

Understanding Voice Assessment Methods

Glowing vocal cord undergoing laser treatment for cancer.

Evaluating voice quality after glottic tumor treatment is complex, involving both subjective and objective measures. Doctors rely on several assessment methods to understand the impact of treatment on your voice.

One common approach is perceptual evaluation, where speech pathologists listen to your voice and rate it based on scales like the Hirano GRBAS scale. This scale assesses five key areas:

Grade (G): Overall severity of the voice problem.
Roughness (R): Irregularity or hoarseness in the voice.
Breathiness (B): Air leakage during speech.
Asthenia (A): Weakness in the voice.
Strain (S): Effort or tension when speaking.

Quantitative acoustic measurements provide objective data about your voice. These tests use specialized tools to analyze various parameters, including:

Fundamental Frequency (F0): The rate of vibration of the vocal folds.
Jitter and Shimmer: Measures of frequency and amplitude variation, respectively.
Noise-Harmonic Ratio (NHR): Measures the amount of noise in the voice.

Another important measurement is maximum phonation time, which assesses the efficiency of your vocal aerodynamics.

The Future of Voice Preservation

Ongoing research and technological advancements continue to refine TLM techniques and optimize voice outcomes. As we move forward, the focus remains on balancing effective cancer treatment with the highest possible quality of life, ensuring that your voice remains a vital part of who you are.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is transoral CO2 laser cordectomy (TLM), and why is it used in treating early glottic cancer?

Transoral CO2 laser cordectomy (TLM) is a type of laser microsurgery used to treat early glottic cancer. It's favored for being a single-session procedure that requires minimal hospitalization and causes reduced morbidity. TLM aims to remove tumors while preserving as much of the vocal cords as possible to maintain voice quality. The evolution of TLM, particularly with the advent of precise micromanipulators and scanner technology, has enhanced its ability to minimize tissue damage, leading to improved voice outcomes. This contrasts with older techniques that sometimes resulted in more tissue damage, impacting voice quality.

How is voice quality assessed after treatments for glottic tumors, and what specific methods are used?

Voice quality following glottic tumor treatment is assessed using both subjective and objective methods. Subjective evaluation includes perceptual assessments like the Hirano GRBAS scale, which rates voice based on Grade (overall severity), Roughness (irregularity), Breathiness (air leakage), Asthenia (weakness), and Strain (effort). Objective assessments involve quantitative acoustic measurements, such as Fundamental Frequency (F0), Jitter and Shimmer (frequency and amplitude variation), and Noise-Harmonic Ratio (NHR), providing data-driven insights into voice characteristics. Maximum phonation time, assessing vocal aerodynamics, is also crucial. All these measures helps to understand impact on the voice.

How does radiotherapy (RT) compare to transoral CO2 laser cordectomy (TLM) as a treatment for early glottic cancer in terms of voice preservation?

Radiotherapy (RT) stands alongside transoral CO2 laser cordectomy (TLM) as a primary treatment option for early glottic cancer, both aiming for high cure rates. Traditionally, RT was sometimes considered superior for voice preservation because early TLM techniques caused more tissue damage. However, modern TLM, with its precise technology, is now comparable, and in some cases, potentially superior, in preserving voice quality. The choice between TLM and RT depends on individual factors and the specific characteristics of the tumor, as well as the potential side effects and long-term impact on voice.

Can you explain what the Hirano GRBAS scale is and how it's used to assess voice quality?

The Hirano GRBAS scale is a perceptual evaluation tool used by speech pathologists to subjectively assess voice quality. It evaluates five key parameters: Grade (G) which is the overall severity of the voice problem, Roughness (R) referring to the irregularity or hoarseness, Breathiness (B) which measures air leakage during speech, Asthenia (A) denoting weakness in the voice, and Strain (S) indicating effort or tension when speaking. Each parameter is rated on a scale, providing a comprehensive profile of voice characteristics as perceived by the human ear. The GRBAS scale provides only a subjective assessment, which can be limited.

What are quantitative acoustic measurements, and what specific parameters do they measure in assessing voice quality?

Quantitative acoustic measurements provide objective data about voice characteristics using specialized tools. These measurements include Fundamental Frequency (F0), which is the rate of vibration of the vocal folds, Jitter and Shimmer, measuring frequency and amplitude variation, and Noise-Harmonic Ratio (NHR), quantifying the amount of noise in the voice. These parameters help doctors understand the physical properties of voice production and how they may be affected by treatments like transoral CO2 laser cordectomy (TLM) or radiotherapy (RT). They offer a data-driven complement to subjective evaluations like the Hirano GRBAS scale. However, these acoustic parameters can't fully describe the perceptual experience of voice quality.