title: Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions.
abstract: OBJECTIVE
  This study investigated multidimensional treatment outcomes, including prognostic factors and side effects of vocal fold steroid injection (VFSI).
  
  
  METHODS
  We recruited 126 consecutive patients, including patients with 49 nodules, 47 polyps, and 30 mucus retention cysts. All the patients received VFSI under local anesthesia in the office settings. Treatment outcomes were evaluated 1 and 2 months after the procedure, including endoscopic evaluation, perceptual voice quality (GRB scores), acoustic analysis, and 10-item Voice Handicap Index (VHI-10).
  
  
  RESULTS
  More than 80% of the patients reported subjective improvements after VFSI. Objective measurements revealed significant improvements from baseline in most of the outcome parameters (P<0.05). Higher occupational vocal demands and fibrotic vocal nodules were significantly associated with poorer clinical responses as measured by the VHI-10 and GRB scores, respectively. For vocal polyps, dysphonia for more than 12 months were significantly associated with higher postoperative VHI-10 scores, whereas patients with laryngopharyngeal reflux (LPR) showed significantly poor postoperative voice quality as measured by GRB scores. Side effects after VFSI included hematoma (27%), triamcinolone deposits (4%), and vocal atrophy (1%), which resolved spontaneously within 1-2 months. Presentation with vocal fold ectasias/varicosities and higher vocal demands were significantly correlated with postoperative vocal hematoma.
  
  
  CONCLUSIONS
  This study demonstrated significant improvements after VFSI in vocal nodules, polyps, and cysts. Occupational vocal demand and subtypes of vocal nodules are closely related to the treatment outcomes after VFSI, whereas symptom duration and LPR were significant prognostic factors for VFSI treatment outcomes in vocal polyps. Side effects after receiving VFSI were mostly self-limited without sequel, whereas the incidence rates might be varied by the injection approach and the timing for postoperative follow-up.
authors.affiliation: Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Chi-Te
authors.initials: CT
authors.lastname: Wang
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: tyhsiao@ntu.edu.tw.
authors.forename: Tzu-Yu
authors.initials: TY
authors.lastname: Hsiao
mesh_terms: D000162:Acoustics; D000293:Adolescent; D000328:Adult; D000368:Aged; D003560:Cysts / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004108:Dilatation, Pathologic; D004185:Disability Evaluation; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015552:Injections, Intralesional; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D013068:Speech Production Measurement; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D014827:Vocal Cords / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D014832:Voice Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D014833:Voice Quality / Q000187:drug effects; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; C004180:dexamethasone 21-phosphate; D003907:Dexamethasone; D014222:Triamcinolone Acetonide
keywords: Atrophy; Cyst; Dexamethasone; Ectasias; Hematoma; Laryngopharyngeal reflux; Nodules; Occupation; Polyp; Triamcinolone; Varicosity; Vocal demand