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Proposed classification system for reporting 532-nm pulsed potassium titanyl phosphate laser treatment effects on vocal fold lesions


  • Pavan S. Mallur MD,

    1. Department of Surgery, Division of Otolaryngology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Michael M. Johns III MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia
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  • Milan R. Amin MD,

    1. Department of Otolaryngology, New York University Voice Center, NYU School of Medicine, New York, New York
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  • Clark A. Rosen MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
    • Send correspondence to Clark A. Rosen, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Voice Center, 1400 Locust Street, Building B, Suite 11500, Pittsburgh, PA 15219. E-mail:

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  • Accepted for presentation at the annual meeting of the American Laryngological Association, Chicago, Illinois, U.S.A., April 27–28, 2011.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.



Currently, no standard exists for reporting treatment results for the potassium titanyl phosphate (KTP) laser. The goal of this study was to establish a validated classification schema for reporting immediate tissue effects after laser treatment.

Study Design

Evaluation of KTP laser video sequences by academic laryngologists with use of the rating system.


A five-point classification system was developed; this included noncontact angiolysis, epithelial blanching, epithelial disruption, contact epithelial ablation, and contact epithelial ablation with tissue removal. Video recordings were made prospectively for each treatment effect. Ten treatment recordings, with two repeated recordings, were presented to seven academic laryngologists, who were asked to categorize each based on the given classification scheme.


Overall accuracy for the combined reviewers in rating the treatments was 82%. Six of seven reviewers showed perfect intrarater reliability. Accuracy in rating clips did not correlate with the previous number of 532-nm KTP or 585-nm pulsed dye laser procedures performed but showed a trend toward correlating with total years in practice. This study reveals that standardized reporting of effects of the KTP laser is feasible.


We believe that results of KTP treatment should be reported using a validated classification system of immediate laser effect, along with specific laser settings. This classification system allows for future systematic evaluation of long-term treatment results prospectively from single laser treatments.

Level of Evidence

4. Laryngoscope, 124:1170–1175, 2014

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