It is well recognised that benign lesions of one vocal cord can give rise to reactive lesions of the contralateral vocal cord directly opposite to the primary lesion. These contralateral reactive lesions (CRLs) are thought to arise due to impact trauma that occurs on phonation. This retrospective cohort study assessed the frequency of CRLs as well as factors associated with their development. In addition, a change in management strategy from resection of CRLs to conservative management of CRLs occurred during the timeframe analysed, permitting comparison of voice outcomes with these different approaches. In the final analysis 268 patients with benign vocal fold lesions (BVFLs) were included, of whom 195 (72.8%) were noted to have CRLs. Never smokers, patients whose symptoms had been present for > 6 months, and a small primary lesion were all noted to be factors associated with a higher chance of having a CRL.

Of the 195 patients with a CRL, 160 (82%) underwent resection of the CRL at the same time as the primary lesion, whilst 35 did not. Three months after surgery, patients who underwent surgical resection were noted to have a trend towards better voice outcomes. The only parameter that showed a statistically significant improvement however was the noise-to-harmonic ratio (NHR, p = 0.04).

The authors acknowledge that the small number of patients who had conservative management limited the ability to detect significant differences in voice outcomes. Overall, accepting the usual limitations associated with retrospective cohort studies, the evidence in this article would tend to suggest that simultaneous excision of primary BVFLs and their associated CRLs (which appear to occur in nearly three-quarters of patients with BVFLs) does not cause any harm, and may in fact be beneficial with respect to voice outcomes. 

Clinical significance of contralateral reactive lesion in vocal fold polyp and cyst.
Cho JH, Choi YS, Joo YH, et al.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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