Surgery and Voice Therapy Are Beneficial for VFP Recovery

How do short-term outcomes compare for treatment of vocal fold polyps (VFPs) with voice therapy alone (VT), surgery alone (SUR), or voice therapy and surgery (VTS)?

Bottom line
When using patient-reported outcomes measures, patients with VFPs receive the greatest short-term gains from treatment paradigms involving SUR or a combination of SUR and VT. VT alone did not result in significant short-term changes.

Background: Historically, phonosurgery was the primary treatment for patients with VFPs. VT has been offered to patients with either vocal fold nodules, those who cannot tolerate surgery, or those who have already received surgery for vocal fold granulomas, polyps, or cysts. Currently, there is no consensus on using VT as a first-line treatment.

Study design: Retrospective case series of 120 patients diagnosed with VFP between January 2010 and April 2016.

Setting: Department of Otolaryngology–Head and Neck Surgery, Division of Laryngology, Mount Sinai Health System, New York City.

Synopsis: Of 120 patients, 23 were in the SUR group, 29 were in the VT group, and 68 were in the VTS group. Mean follow-up was 5.5 months. All patients with polyps ≥50% of the vocal fold length or width received surgical treatment. Of the 10% of random examinations reviewed, raters agreed with the original chart reports 85.1% of the time when looking at absence/presence of VFP. Inter-rater reliability for reviewers was 81.1% based on presence/absence of VFP and 88.2% based on size and configuration characteristics. Pre-intervention VHI-10 scores were 15.4 (VT), 22.2 (SUR), and 21.2 (VTS). There was a significant improvement from pre- to post-treatment VHI-10 scores in the SUR and VTS groups compared to the VT group. Complete physical resolution of polyps was seen in 73.9% (SUR), 27.6% (VT), and 85.3% (VTS). Complete symptomatic resolution was seen in 56.5% (SUR), 41.4% (VT), and 64.7% (VTS).

Citation: Agarwal J, Wong A, Karle W, et al. Comparing short-term outcomes of surgery and voice therapy for patients with vocal fold polyps. Laryngoscope. 2019;129:1067–1070.