Awake Blue Light vs. KTP Laser Treatment for Vocal Fold Lesions: A Randomized Controlled Trial

OBJECTIVE: To compare clinical outcomes of a 445-nm blue light (BL) laser with the established 532-nm potassium titanyl phosphate (KTP) laser for office-based treatment of benign vocal fold lesions. METHODS: In this parallel-group, open-label randomized controlled trial, adults (≥ 18 years) with benign vocal fold lesions underwent baseline VHI-10 and laryngeal stroboscopy, followed by in-office laser treatment. Pain visual analogue scale (VAS) scores were collected at baseline and daily for 7 days after the procedure. The primary outcome was the between-group difference in the change in Voice Handicap Index-10 (VHI-10) scores. Secondary outcomes included between-group comparisons of post-procedural pain and stroboscopic parameters at 90 days after treatment. Linear mixed-effects model assessed changes in VHI-10 and pain VAS over time, while Cochran-Mantel-Haenszel and logistic regression tests compared stroboscopy outcomes. RESULTS: Ninety-eight patients were enrolled (49 per group). Baseline characteristics were similar aside from a slightly younger age in the KTP group (p = 0.048). VHI-10 scores improved significantly in both groups at postoperative day (POD)7 (-5.98), POD30 (-9.28), and POD90 (-12.43) (all p ≤ 0.001), with no between-group differences (p = 0.596). Pain decreased significantly over time (p < 0.001), without group differences (p = 0.47). At POD90, complete vocal fold closure occurred in 91.2% (BL) and 85.7% (KTP) of patients (p = 0.74). Normal mucosal wave was observed in 79.4% (BL) and 81.0% (KTP), with no significant differences. CONCLUSION: BL laser demonstrated clinical outcomes comparable to KTP, with similar voice improvement, pain reduction, and stroboscopic results.