Summary
Objective
Previous studies indicate that certain voice outcomes can improve following a single
office-based steroid injection with voice therapy for vocal fold scar. We evaluated
voice outcomes after a series of three timed office-based steroid injections with
voice therapy.
Study Design
Retrospective case series with chart review.
Setting
Academic medical center.
Methods
We evaluated pre-and postprocedural patient-reported, perceptual, acoustic, aerodynamic,
and videostroboscopic parameters. We evaluated 23 patients who underwent three office-based
dexamethasone injections into the superficial lamina propria one month apart. All
patients pursued voice therapy.
Results
Voice Handicap Index (n = 19; P= .030) decreased after injection series. Total GRBAS
score (grade, roughness, breathiness, asthenia, strain) decreased (n = 23; P = 0.001). Dysphonia severity index score improved (n = 20; P = 0.041). Phonation threshold pressure did not decrease significantly (n = 22; P = 0.536). Videostroboscopic parameters of vocal fold edge (P = 0.023), right mucosal wave (P = 0.023) improved or normalized after injection series. Glottic closure (P = 0.134) did not improve.
Conclusions
Series of three office-based steroid injections combined with voice therapy for vocal
fold scar does not appear to provide further benefit than one injection. Despite lack
of improvements of PTP and other parameters, injection series is likewise unlikely
to worsen dysphonia. A partially negative study provides value in investigation of
less invasive treatment alternatives for a disorder that is challenging to treat.
Future studies exploring effects of voice therapy alone without other intervention
and consideration of sham injection versus steroid injection are warranted.
Key Words
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REFERENCES
- Prevalence and causes of dysphonia in a large treatment-seeking population.Laryngoscope. 2012; 122: 343-348
- Hoarseness-causes and treatments.Dtsch Arztebl Int. 2015; 112: 329-337
- Self-reported impact of dysphonia in a primary care population: an epidemiological study.Laryngoscope. 2010; 120: 2022-2032
- Vocal fold scarring: current concepts and management.Otolaryngol Head Neck Surg. 1996; 115: 474-482
- Phonosurgery: basic and clinical investigations.Otologia (Fukuoka). 1975; 21: 239-440
- Pathophysiology of acute wound healing.Clin Dermatol. 2007; 25: 9-18
- Histologic and rheologic characterization of vocal fold scarring.J Voice. 2002; 16: 96-104
- Thyroplasty as a new phonosurgical technique.Acta Otolaryngol. 1974; 78: 451-457
- Local vascularized flaps for augmentation of Reinke's space.Laryngoscope. 2011; 121: S37-S60
- Treatment of sulcus vocalis: auditory perceptual and acoustical analysis of the slicing mucosa surgical technique.J Voice. 1993; 7: 365-376
- Prospective multi-arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis.Laryngoscope. 2011; 121: 1252-1260
- Voice outcomes following a single office-based steroid injection for vocal fold scar.Otolaryngol Head Neck Surg. 2016; 155: 820-828
- Office steroid injections of the larynx.Laryngoscope. 2006; 116: 1735-1739
- Is voice rest never indicated?.J Voice. 1989; 3: 87-91
- Randomized controlled trial of supplemental augmentative and alternative communication versus voice rest alone after phonomicrosurgery.Otolaryngol Head Neck Surg. 2015; 152: 494-500
- The voice handicap index (VHI): development and validation.Am J Speech Lang Pathol. 1997; 6: 66-70
- Validity and reliability of the glottal function index.Arch Otolaryngol Head Neck Surg. 2005; 131: 961-964
- Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (VRQOL and IPVI) documentation of voice disorders.J Voice. 2007; 21: 576-590
- Validity and reliability of the reflux symptom index (RSI).J Voice. 2002; 16: 274-277
- Clinical Examination of Voice.Springer Verlag, New York, NY1981
- The dysphonia severity index: an objective measure of vocal quality based on a multiparameter approach.J Speech Lang Hear Res. 2000; 43: 796-809
- Histologic study of acute vocal fold wound healing after corticosteroid injection in a rabbit model.Ann Otol Rhinol Laryngol. 2010; 119: 133-139
- Patient tolerance of in-office pulsed dye laser treatments to the upper aerodigestive tract.Otolaryngol Head Neck Surg. 2006; 134: 1023-1027
- Safety and cost effectiveness of intra-office flexible videolaryngoscopy with transoral vocal fold injection in dysphagic patients.Am J Otolaryngol. 2006; 27: 319-322
- Office-based laryngeal laser surgery with the 532-nm pulsed-potassium-titanyl-phosphate laser.Curr Opin Otolaryngol Head Neck Surg. 2007; 15: 394-400
- Office-based photoangiolytic laser treatment of Reinke's edema: safety and voice outcomes.Otolaryngol Head Neck Surg. 2015; 152: 1075-1081
- Complications of suspension laryngoscopy.Ann Otol Rhinol Laryngol. 2002; 111: 972-976
- Cost savings of unsedated office-based laser surgery for laryngeal papillomas.Ann Otol Rhinol Laryngol. 2007; 116: 45-48
- Current understanding and review of the literature: vocal fold scarring.J Voice. 2006; 20: 110-120
- Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European Laryngological Society.Eur Arch Otorhinolaryngol. 2013; 270: 2491-2507
- Intratympanic steroid injections as a salvage treatment for sudden sensorineural hearing loss: a randomized, double-blind, placebo-controlled study.Otol Neurotol. 2011; 32: 774-779
- Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy.Laryngoscope. 2007; 117: 3-15
- The effect of intratympanic steroid injection frequency in idiopathic sudden sensorineural hearing loss.Am J Otolaryngol. 2018; 39: 688-692
- Comparison of 2 and 4 intratympanic steroid injections in the treatment of idiopathic sudden sensorineural hearing loss.Ann Otol Rhinol Laryngol. 2018; 127: 235-240
- The use of corticosteroids to treat keloids: a review.Int J Low Extrem Wounds. 2008; 7: 137-145
- Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives.Clin Cosmet Investig Dermatol. 2018; 11: 387-396
- The risk of vocal fold atrophy after serial corticosteroid injections of the vocal fold.J Voice. 2016; 30: 762.e11-762.e13
- Laryngeal steroid injection.Curr Opin Otolaryngol Head Neck Surg. 2009; 17: 424-426
- Local steroid injection via the cricothyroid membrane in patients with vocal nodule.Arch Otolaryngol Head Neck Surg. 2011; 137: 1011-1016
- Serial intralesional steroid injection for subglottic stenosis: systemic side effects and impact on surgery-free interval.OTO Open. 2021; 52473974X211054842
- Sulcus vocalis: a rational analytical approach to diagnosis and management.Ann Otol Rhinol Laryngol. 1996; 105: 189-200
- Vocal fold scars: a common classification proposal by the American Laryngological Association and European Laryngological Society.Eur Arch Otorhinolaryngol. 2019; 276: 2289-2292
- Dependence of phonation threshold pressure on vocal tract acoustics and vocal fold tissue mechanics.J Acoust Soc Am. 2006; 119: 2351-2362
WHO; World Health Organization. Statement on Public Disclosure of Clinical Trial Results. April 2015. Available at: https://www.who.int/clinical-trials-registry-platform/reporting-on-findings. Accessed September 15, 2021.
- The importance of publishing trials with negative results.Am J Obstet Gynecolo. 2017; 216: 541-542
- Non-publication of large randomized clinical trials: cross sectional analysis.BMJ. 2013; 347: f6104
- Lack of transparency in publishing negative clinical trial results.Clin Podiatr Med Surg. 2020; 37: 385-389
- In praise of replication studies and null results.Nature. 2020; 578: 489-490
Article info
Publication history
Published online: April 17, 2023
Accepted:
February 27,
2023
Publication stage
In Press Corrected ProofFootnotes
This article was presented as a poster at the Combined Otolaryngology Spring Meetings (COSM) 2022 (Dallas, Texas; April 27-May 1, 2022) and as an oral presentation at the Wisconsin Society of Otolaryngology Annual Meeting (Wisconsin Dells, Wisconsin; October 15-16, 2022).
Funding: None.
Identification
Copyright
Published by Elsevier Inc. on behalf of The Voice Foundation.
