Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions
Journal
Journal of Voice
Journal Volume
29
Journal Issue
5
Start Page
578
End Page
587
Date Issued
2015
Author(s)
Abstract
Objective. This study investigated multidimensional treatment outcomes, including prognostic factors and side effects of vocal fold steroid injection (VFSI). Methods. We recruited 126 consecutive patients, including patients with 49 nodules, 47 polyps, and 30 mucus retention cysts. All the patients received VFSI under local anesthesia in the office settings. Treatment outcomes were evaluated 1 and 2 months after the procedure, including endoscopic evaluation, perceptual voice quality (GRB scores), acoustic analysis, and 10-item Voice Handicap Index (VHI-10). Results. More than 80% of the patients reported subjective improvements after VFSI. Objective measurements revealed significant improvements from baseline in most of the outcome parameters (P < 0.05). Higher occupational vocal demands and fibrotic vocal nodules were significantly associated with poorer clinical responses as measured by the VHI-10 and GRB scores, respectively. For vocal polyps, dysphonia for more than 12 months were significantly associated with higher postoperative VHI-10 scores, whereas patients with laryngopharyngeal reflux (LPR) showed significantly poor postoperative voice quality as measured by GRB scores. Side effects after VFSI included hematoma (27%), triamcinolone deposits (4%), and vocal atrophy (1%), which resolved spontaneously within 1-2 months. Presentation with vocal fold ectasias/varicosities and higher vocal demands were significantly correlated with postoperative vocal hematoma. Conclusions. This study demonstrated significant improvements after VFSI in vocal nodules, polyps, and cysts. Occupational vocal demand and subtypes of vocal nodules are closely related to the treatment outcomes after VFSI, whereas symptom duration and LPR were significant prognostic factors for VFSI treatment outcomes in vocal polyps. Side effects after receiving VFSI were mostly self-limited without sequel, whereas the incidence rates might be varied by the injection approach and the timing for postoperative follow-up. ? 2015 The Voice Foundation.
Subjects
Atrophy; Cyst; Dexamethasone; Ectasias; Hematoma; Laryngopharyngeal reflux; Nodules; Occupation; Polyp; Triamcinolone; Varicosity; Vocal demand
Other Subjects
dexamethasone sodium phosphate; triamcinolone; dexamethasone; dexamethasone 21-phosphate; glucocorticoid; triamcinolone acetonide; adult; aged; Article; drug safety; female; hematoma; human; laryngopharyngeal reflux; larynx disorder; major clinical study; male; outcomes research; prognostic assessment; scoring system; treatment outcome; treatment response; vocal cord disorder; voice; acoustics; adolescent; analogs and derivatives; convalescence; Cysts; disability; drug effects; intralesional drug administration; Laryngeal Diseases; laryngoscopy; lesions and defects; middle aged; pathology; pathophysiology; Polyps; prospective study; speech analysis; time factor; vocal cord; Voice Disorders; young adult; Acoustics; Adolescent; Adult; Aged; Cysts; Dexamethasone; Dilatation, Pathologic; Disability Evaluation; Female; Glucocorticoids; Humans; Injections, Intralesional; Laryngeal Diseases; Laryngoscopy; Male; Middle Aged; Polyps; Prospective Studies; Recovery of Function; Speech Production Measurement; Time Factors; Treatment Outcome; Triamcinolone Acetonide; Vocal Cords; Voice Disorders; Voice Quality; Young Adult
Type
journal article