title: Intralesional steroid injection for benign vocal fold disorders: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Emerging literature had documented the potential usefulness of vocal fold steroid injection (VFSI) as an alternative treatment option for benign vocal lesions. This study aims to conduct a qualitative synthesis and quantitative meta-analysis of vocal fold steroid injection
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Electronic databases were searched using relevant keywords. Extracted data include author, year of publication, diagnosis, steroid regimen, recurrence and side effects. Reported treatment outcomes were clustered into five categories, i.e. subjective, perceptual, acoustic, aerodynamic, and stroboscopic. Meta-analyses were performed on studies with numerical results using random effects model.
  
  
  RESULTS
  Six articles were identified with a total of 321 patients. All the studies reported significant improvements after VFSI in each category of outcome measurements. Proposed indications for VFSI include vocal nodules, polyp/cyst, Reinke's edema, and scar. Meta-analysis demonstrated a significant increase in maximal phonation time after VFSI by 1.82 seconds (p<0.001, 95% confidence interval (CI): 0.29 ≈ 3.35) and a 27.61 points decrease in voice handicap index (p<0.001, 95% CI: 16.49 ≈ 38.73). Adverse effects include local hematoma, whitish deposition of triamcinolone, and mild vocal fold atrophy, which resolve spontaneously within 1 to 2 months. The recurrence rate after VFSI was between 4% and 31%.
  
  
  CONCLUSIONS
  VFSI is well-tolerated under local anesthesia in the office setting. The invasiveness and morbidity of VFSI are low and the side effects are self-limited. Meta-analyses demonstrated significant improvements from both objective and subjective measurements. Further controlled studies with longer follow-up periods may evaluate the effectiveness of VFSI more reliably.
authors.affiliation: Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Chi-Te
authors.initials: CT
authors.lastname: Wang
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Liao
authors.forename: Po-Wen
authors.initials: PW
authors.lastname: Cheng
authors.forename: Wu-Chia
authors.initials: WC
authors.lastname: Lo
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
mesh_terms: D006801:Humans; D015552:Injections, Intralesional; D007819:Laryngeal Edema / Q000473:pathology*; D011127:Polyps / Q000473:pathology*; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014827:Vocal Cords / Q000473:pathology*; D014832:Voice Disorders / Q000188:drug therapy / Q000473:pathology*
chemical_list: D013256:Steroids