title: Contralateral Vocal Fold Reactive Lesions: Nomenclature, Treatment Choice, and Outcome.
abstract: Contralateral reactive lesions (RLs) represent a distinct entity among benign bilateral vocal fold (VF) lesions. Lack of uniform nomenclature and a myriad of surgical options have hampered attempts to develop treatment guidelines. The objective of this study is to better define RLs and their prognosis, through the development of a standard nomenclature, with an aim to guide treatment and delineate the role of phonosurgery.
  
  
  
  Case series with chart review.
  
  
  
  Tertiary care center.
  
  
  
  Analysis was performed on patients with Current Procedural Terminology code 31545. Operative reports with a primary lesion and contralateral RL were included. Outcomes included the Voice Handicap Index-10 (VHI-10) and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, lesion persistence/recurrence, mucosal wave, and edge character based on blinded videostroboscopy review.
  
  
  
  A nomenclature was developed based on intraoperative RLs (n = 30), defined by lesion consistency (fibrous or polypoid) and relationship to normal VF edge (gradual or steep). Reactive lesion treatment included no intervention, excision, potassium titanyl phosphate laser, steroid injection, or a combination thereof. Observations included the following: inconsistent treatment modalities were employed, excision of RLs did not yield better outcomes, fibrous RLs were more likely to persist and polypoid lesions more likely to recur, gradual lesions were more likely to remain disease free, and most treatments showed improved mucosal wave, VHI-10, and GRBAS.
  
  
  
  Reactive lesions have not been well classified, and treatments are based on subjective intraoperative decision making with unpredictable outcomes. The nomenclature proposed will allow for a better definition of the RL and provide a framework for future research to identify optimal treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA skoss@nyee.edu.
authors.forename: Shira L
authors.initials: SL
authors.lastname: Koss
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Kidwai
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center, New York, New York, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pitman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000145:classification* / Q000628:therapy*; D008297:Male; D011379:Prognosis; D009626:Terminology as Topic; D016896:Treatment Outcome; D014827:Vocal Cords / Q000473:pathology*; D014833:Voice Quality
keywords: contralateral vocal fold lesion; nomenclature; phonosurgery; reactive vocal fold lesion