Meta‐analysis of Vocal Fold Steroid Injection

Abstract

Objective: In recent decades, emerging literature had pointed out the usefulness of vocal fold steroid injection (VFSI) as an alternative treatment option for benign vocal lesions, especially when conservative management and/or surgery are not applicable. This study intends to review the existing literature and to quantify the clinical effectiveness using meta-analysis. Method: Electronic databases were systematically searched using relevant keywords. Extracted data included author, year of publication, diagnosis, steroid regimen and recurrence. Reported treatment outcomes were clustered into 5 categories, ie, subjective, perceptual, acoustic, aerodynamic and stroboscopic. Meta-analysis was conducted among studies with available numerical data before and after VFSI. Results: Six articles were identified with a total of 321 patients. All the studies reported significant improvement after VFSI in all categories of outcome measurements. VFSI were used to treat vocal nodules, polyp/cyst, Reinke’s edema, and scar. Meta-analysis demonstrated a 1.94 second improvement of maximal phonation time ( P < .001, 95% confidence interval [CI]: 0.96 to 2.92) and a 27.61 points decrease of voice handicap ( P < .001, 95% CI: 16.49~38.73 16.49). Adverse effects include local hematoma, whitish plaque deposition, and mild vocal fold atrophy, which resolve spontaneously within 1 month. Recurrence rate after VFSI ranged from 4% to 31%. Conclusion: This study demonstrated that VFSI is well tolerated under local anesthesia in the office setting. Pooled estimate from meta-analysis showed significant objective and subjective improvements after VFSI. Further controlled studies are mandatory to delineate the role of VFSI in the treatment of benign vocal fold lesions.