This retrospective cohort study assessed a single surgeon’s outcomes before and after the routine administration of intralesional triamcinolone following microsurgical removal of benign vocal fold lesions (polyps, nodules and cysts). A total of 211 patients were recruited for the study. Of these, 127 patients were treated with surgery alone and 84 were treated with surgery and an immediate injection of 0.5ml triamcinolone acetonide (10mg/ml) into Reinke’s space.
No significant differences were noted in the improvement of voice outcomes between the two groups, as assessed by parameters including GRBAS, VHI score and maximum phonation time. It was however reported that videostroboscopic examination at three months after surgery showed that recurrence was significantly higher in the group treated with surgery alone (24% vs 9%, p = 0.014), correlating with a similar rate of ‘persistent dysphonia’ (30% vs 11%).
Vocal atrophy at two weeks was noted in 16% of patients treated with surgery and steroids (0% for surgery alone); this improved to 2% at two months’ postoperatively. Multivariate analysis suggested that patients over 50 and patients whose preoperative dysphonia was longer than six months were more likely to have persistent dysphonia postoperatively. Overall, the retrospective nature of this study, the lack of assessor blinding and the similarity in objective measures of voice outcomes between the two study groups mean that insufficient evidence has been provided to recommend routine intralesional steroid injections following microsurgical excision of benign vocal fold lesions. Nevertheless, it would seem reasonable to consider using adjunctive intralesional steroids for patients with recurrent pathology. As acknowledged by the authors, a prospective randomised controlled trial is required to assess more rigorously the efficacy and safety of adjunctive steroid injections following laryngeal microsurgery.