Wang Chi-Te, Lai Mei-Shu, Cheng Po-Wen
Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan2Department of Otolaryngology-Head and Neck Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan3Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 1;143(6):589-594. doi: 10.1001/jamaoto.2016.4418.
The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI.
To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013.
All participants underwent VFSI.
Long-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI.
The 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%).
This study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.
声带类固醇注射（VFSI）的短期疗效已有充分记录。然而，很少有研究报告VFSI后的长期疗效。
调查VFSI治疗良性声带病变后症状复发和二次干预的发生率。
设计、设置和参与者：这项前瞻性队列研究在台湾台北的一家三级转诊医疗中心进行。该队列包括189例声带病变患者，他们在2011年8月至2013年9月期间接受了VFSI作为主要治疗。
所有参与者均接受了VFSI。
通过结构化电话访谈和在2年期间每6个月回顾一次病历进行长期监测。我们评估了10项嗓音障碍指数、发声困难症状，以及患者在初次VFSI后是否接受了任何额外干预。
189名参与者（32名男性和157名女性；平均[标准差]年龄，39[10]岁[范围，20 - 74岁]）包括因声带小结（n = 72）、息肉（n = 72）或黏液潴留囊肿（n = 45）接受VFSI的患者。VFSI后，141名患者（74.6%；23名男性和118名女性；平均年龄，39岁[范围，20 - 70岁]）显示出阳性反应（即临床症状显著缓解，无需额外手术）并接受了长期监测。中位随访期为19.4个月，2例患者在术后1年内失访。VFSI后6、12、18和24个月的累积失败率（主观症状复发加二次治疗）分别为12%、17%、24%和32%。当将对VFSI的初始反应率（189例中的141例，74.6%）综合考虑时，在最初招募的189例患者中，50%在2年后VFSI仍然有效。VFSI长期有效性最高的是声带息肉（54%），其次是小结（49%）和囊肿（43%）。
本研究表明，VFSI在处理良性声带病变方面可能有益，特别是在一线治疗不合适时。然而，本研究的长期结果表明，相当数量的患者在VFSI后2年内出现症状复发或接受后续干预；在医疗决策中应考虑这一点。
