Treatment Efficacy of Voice Therapy for Vocal Fold Polyps and Factors Predictive of Its Efficacy
Introduction
A vocal fold polyp is usually a unilateral lesion occurring on the vocal folds and is a common benign laryngeal lesion. Phonotrauma disrupts the microstructure in the superficial layer of the lamina propria (Reinke's space). This trauma induces local edema, which contributes to subsequent formation of hyalinized stroma, vocal fold polyps, or nodules.1 Repeated injuries to the true vocal fold induce permanent changes and disturbances in the mucosal vibration, and closure of the vocal fold induces voice changes, hoarseness, and increased vocal effort.2 Vocal fold polyps can be observed in various forms, such as sessile versus pedunculated types, and hemorrhagic versus non-hemorrhagic types.3 These distinct features are likely to attribute to different stages or etiologies of polyp formation.
Whereas the preferred treatment for vocal fold nodules involves a conservative management approach, vocal fold polyps are treated with either surgical or non-surgical therapies.4, 5 Traditionally, surgical therapy, such as resection under the guidance of a laryngomicroscope with mucosa preservation, has been preferred with expected spontaneous healing.5, 6 Voice therapy or vocal hygiene education plays an adjunctive role after surgery. Surgery as a treatment modality has the associated risks of general anesthesia and voice aggravation induced by scar formation following surgery. However, current studies have proposed conservative treatments, including voice therapy and vocal hygiene, as acceptable alternative definite therapies to improve voice outcome.7 Although conservative management has a longer duration than surgical treatment and may require guidance from a speech language pathologist, the avoidance of invasive surgical treatment may override those limitations.
Definitive treatment guidelines for choosing surgery or conservative management for the treatment of vocal fold polyps have not yet been established. Vocal polyps of a small size, with hemorrhagic features, and occurring in females show a better response to voice therapy or vocal hygiene education.4, 8, 9 It is necessary to find predicting factors related to effective response to voice therapy when deciding treatment modality for vocal fold polyps. Here, this study was designed to analyze the success rate of voice therapy and determining factors for response to voice therapy for vocal fold polyps.
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Participants
We performed a retrospective cohort study of consecutive patients who underwent voice therapy from January 2012 to December 2013 at Asan Medical Center, Seoul, Korea. This study was approved by our Institutional Review Board. Ninety-two patients over 18 years old and diagnosed with vocal fold polyp(s) upon videostroboscopy were enrolled for voice therapy. Patients with history of previous treatment (either surgical or non-surgical therapy), other types of accompanying organic lesions, missing
Results
The age range of the subjects (41 males and 51 females) was 22–72 years, with an average age of 51. After voice therapy, 40 patients showed polyp shrinkage more than 50% and did not undergo surgical treatment, whereas 52 patients showed no significant change and 41 patients of them (78.8%) underwent laryngomicroscopic surgery. By univariate analysis, female patients (n = 28, 54.9%) presented a good response to voice therapy compared with male patients (n = 12, 29.3%, P = 0.01; Table 1). Age and
Discussion
This study evaluated the efficacy of voice therapy for vocal fold polyp. Our protocol for vocal fold polyp prefers voice therapy for vocal fold polyp as an initial approach to avoid unnecessary surgical resection.11 In our present study, 40 of the enrolled patients (43.8 %) improved after they received voice therapy. Patients with small polyps and female patients showed the most effective response to voice therapy. Among our cases of small polyps, the sessile type rather than the pedunculated
Conclusions
Voice therapy is a feasible treatment approach for a vocal fold polyp. Female patients and small vocal fold polyps are positive indicators for voice therapy. In small-sized polyps, in particular, the sessile type responds to voice therapy more frequently compared with the pedunculated type. These factors should be considered when choosing a treatment modality for a vocal fold polyp, and the findings of our current study may help such patients to avoid unnecessary surgical resection and instead
Acknowledgment
This study was supported by a grant (2014-620) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.
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Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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These authors contributed to this article equally.