Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions

Abstract

Importance: The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI.

Objective: To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions.

Design, setting, and participants: This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013.

Exposures: All participants underwent VFSI.

Main outcomes and measures: Long-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI.

Results: The 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%).

Conclusions and relevance: This study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. No disclosures were reported.

Figures

Figure 1.. Long-term Surveillance in the 141 Patients Who Showed Positive Improvement Following Initial Vocal Fold Steroid Injection (VFSI)

The cumulative incidence rates of symptom recurrence at 6, 12, 18, and 24 months after VFSI were 5%, 8%, 13%, and 19%, respectively. The cumulative incidence rates for receiving secondary interventions at 6, 12, 18, and 24 months were 7%, 10%, 13%, and 17%, respectively. Altogether, the cumulative failure rates (symptom recurrence plus receiving secondary interventions) at 6, 12, 18, and 24 months were 12%, 17%, 24%, and 32%, respectively.

Figure 2.. Subgroup Analyses of Long-term Surveillance in the 141 Patients Who Showed Positive Improvement Following Initial Vocal Fold Steroid Injection (VFSI)

After 2 years, patients with mucus-retention cysts showed higher cumulative treatment failure rates (39%) (ie, symptom recurrence or receiving secondary intervention) than did those with polyps (33%) or nodules (31%).