Baali Mohammed H, Shaheen Mohammad H, Khan Meshal F, Neazy Abdulaziz A, Basyuni Mohammed A, Altowairqi Abdulaziz
Otolaryngology - Head and Neck Surgery Department, King Abdulaziz Specialist Hospital, Taif, SAU.
Otolaryngology - Head and Neck Surgery Department, Hera General Hospital, Makkah, SAU.
Cureus. 2024 Dec 17;16(12):e75916. doi: 10.7759/cureus.75916. eCollection 2024 Dec.
Vocal cord nodules (VCNs) can be treated with a variety of therapeutic approaches, with controversy regarding the optimal management. This review provides an overview of the most commonly used management strategies and their outcomes to enhance decision making. We conducted a systematic literature search on PubMed, Web of Science, and Scopus to include relevant original articles published in peer-reviewed journals from inception through April 2024. We used a broad search strategy including the following search keywords: "Vocal" AND "Nodules" OR "Lesions." All interventions were included, such as speech or voice therapy, medication, surgery, and other therapies. Two authors independently conducted initial screening, full-text screening, inclusion, and data collection. Disagreements were settled by consensus or, if persistent, by a senior author. A total of 18 articles were included in the current scoping review. Voice therapy is highlighted as the preferred non-invasive treatment; however, it requires a longer duration to show results. In children, voice therapy is further limited by non-compliance, which may result in delayed recovery and increased psychological and economic burden. Surgery offers immediate improvements but necessitates postoperative voice therapy to prevent recurrence. In hard or mature nodules, surgery showed superior efficacy compared to voice therapy. Pharmacotherapy is principally indicated to treat an underlying disease and is often prescribed as an adjunct to voice therapy. Patient age, duration of the disorder, morphological features of VCNs, and compliance with voice therapy are significant prognostic factors in determining the success or failure of different treatment modalities. We propose a management algorithm that incorporates these key factors to assist in effective management and decision making. In addition, the management of VCNs requires a methodical approach that considers the prognostic factors associated with each treatment modality. We propose a key-factor-based algorithm that incorporates these factors to assist in therapeutic decision making and guide future research toward establishing definitive guidelines.
声带小结（VCNs）可以采用多种治疗方法进行治疗，但对于最佳治疗方案仍存在争议。本综述概述了最常用的治疗策略及其效果，以促进决策制定。我们在PubMed、科学网和Scopus上进行了系统的文献检索，纳入了从创刊至2024年4月在同行评审期刊上发表的相关原创文章。我们采用了广泛的检索策略，包括以下检索关键词：“声带”和“小结”或“病变”。所有干预措施均被纳入，如言语或嗓音治疗、药物治疗、手术治疗及其他治疗。两位作者独立进行初步筛选、全文筛选、纳入和数据收集。分歧通过协商解决，若仍存在分歧，则由资深作者决定。本综述共纳入18篇文章。嗓音治疗被视为首选的非侵入性治疗方法；然而，其显效时间较长。在儿童中，嗓音治疗还因患儿不配合而受到进一步限制，这可能导致恢复延迟以及心理和经济负担增加。手术可立即改善症状，但术后需要进行嗓音治疗以防止复发。对于坚硬或成熟的小结，手术治疗的疗效优于嗓音治疗。药物治疗主要用于治疗潜在疾病，通常作为嗓音治疗的辅助手段。患者年龄、疾病持续时间、声带小结的形态特征以及对嗓音治疗的依从性是决定不同治疗方式成败的重要预后因素。我们提出了一种管理算法，纳入这些关键因素以协助进行有效的管理和决策。此外，声带小结的管理需要一种有条不紊的方法，考虑与每种治疗方式相关的预后因素。我们提出了一种基于关键因素的算法，纳入这些因素以协助进行治疗决策，并指导未来的研究以建立明确的指南。
