Introduction 1 2 2 Quantitative acoustic measurements are more regularly studied. These are obtained from tools that digitize and analyze the voice being investigated and quantify the characteristics that deviate from normality, understanding normality to mean when the voice is uniform in both amplitude and tone periodicity. The addition of noise to the voice signal is also a defect that affects voice quality, and this is the third acoustic characteristic that is studied using spectrography. 3 4 5 In this study, we present the objective and subjective analysis of voice quality following treatment of an early epidermoid glottic carcinoma. Results from the objective evaluation of the voice, along with the self-evaluation of voice quality quantified using the Voice Handicap Index of a group of patients treated with endoscopic laser surgery are compared with patients treated with radiotherapy. Materials and methods 6 . 2 GRBAS 3 F 0 Acoustic and spectrographic analysis Doctor Speech Voice Assessment F 0 Speech Analysis 7 Aerodynamic efficiency analysis This consisted in measuring the maximum phonation time (TMF) for the “a” vocal after instructing the patient to sustain this vocal for the longest time possible at a comfortable pitch and intensity. The patients were asked to repeat the test at least three times and the highest value was retained. Patient self-perception analysis (Voice Handicap Index) 5 Statistical analysis t P Results 2 In both groups, all lesions corresponded to stage I of the TNM classification. In the group of 19 patients treated with surgery, all the lesions were qualified as T1a and in the case of the 18 radiotherapy patients, 13 were classified as T1a and 5 as T1b. No metastases in the neck, or distant, were detected. At the time of the study, all patients were free from illness. In the group of patients treated with radiotherapy, the nominal total dose was 6,525 cGy, with 225 cGy daily doses for a total of 29 days. Of the PTV volume, 100% received minimum doses of approximately 5,700 cGy, a maximum dose of approximately 6,720 cGy and an average dose of 6,520 cGy. Aerodynamic efficiency and spectrographic analysis 1 F 0 Table 1 n n Variable Laser Radiotherapy  MPT 11.83 ± 5.28 8.63 ± 3.23 P F 0 173.39 ± 47.41 199.04 ± 51.46 NS Jitter (%) 0.44 ± 0.24 0.72 ± 0.91 NS Shimmer (%) 5.08 ± 4.72 4.07 ± 4.04 NS NNE (dB) −5.82 ± 2.98 −5.02 ± 4.44 NS MPT F 0 NNE P Perceptual dysphonia analysis (GRBAS) 2 2 3 P Table 2 2 n  0 1 2 3 Total G 0% 31.5% (6) 37% (7) 31.5 (6) 100% (19) R 10.5% (2) 58% (11) 26% (5) 5.5% (1) 100% (19) A 21% (4) 42% (8) 21% (4) 16% (3) 100% (19) B 84% (16) 16% (3) 0% 0% 100% (19) S 31.5% (6) 31.5% (6) 21% (4) 16% (3) 100% (19) G R A B S Table 3 n  0 1 2 3 Total G 11.1% (2) 44.4% (8) 27.8% (5) 16.7%(3) 100% (18) R 55.6% (10) 33.3% (6) 5.6% (1) 5.6% (1) 100% (18) A 55.6% (10) 33.3% (6) 11.1% (2) 0% 100% (18) B 44.4% (8) 27.8% (5) 22.2% (4) 5.6% (1) 100% (18) S 77.8% (14) 16.7% (3) 5.6% (1) 0% 100% (18) G R  A B S Patients self-perception analysis (Voice Handicap Index) 4 Table 4 Averages obtained from the “Voice Handicap Index” questionnaire in the functional, physical and emotional scales, as well as the scores obtained in both groups  Laser  Radiotherapy  Functional 11.47 (0–32) 2.83 (0–17) P Physical 12.68 (0–31) 6.22 (0–18) NS Emotional 4.63 (0–20) 0.61 (0–5) P Global 28.79 (0–77) 9.67 (0–29) P Discussion 8 9 2 2 10 11 12 13 15 16 18 19 21 F 0 2 22 24 13 2 18 In terms of the spectrograms obtained in both groups, no statistically significant differences were found. According to our results, 48% of patients treated with laser, and 44% of radiotherapy patients have an aesthetically acceptable voice (type I and II dysphonia). 20 2 25 26 While acoustic, physiological and perceptual measurements are important parameters in assessing vocal function, they do not provide information about the patient’s perception of their own voice quality. Given that voice quality, because of its potential impact on quality of life, can be an important factor in the choice of treatment, it is important to include this information when evaluating results. Not only should dysphonia as a by-product of laryngeal physiology be considered, but also the effects on patient quality of life must be considered as well. 27 In our study, low scores were obtained for both groups in the three scales, functional, physical and emotional. This could imply reduced impact in the quality of life of patients treated either with laser surgery or radiotherapy. The statistically significant differences are in favor of radiotherapy patients in the functional and emotional scales, as well as the global scores. Although acoustic and perceptual voice analysis in both groups showed no significant differences, the radiotherapy group scored less in the VHI than the surgical group. 20 2 21 28 2 28 19 29 2 Conclusions 2