Recent survey data looking at the opinions and practices of otolaryngologists in the US and the UK demonstrate that there is a wide variation in recommendations made for voice rest after vocal fold surgery. In the US, the most common recommendation for relative or complete voice rest is seven days, but a sizable minority of survey respondents (15%) did not recommend any voice rest at all. This lack of consistency reflects the absence of a robust evidence base to guide voice rest recommendations. In this study, 31 patients undergoing laryngeal microsurgery for leukoplakia, CIS, polyps, Reinke’s oedema or cysts were randomised to either three or seven days of absolute voice rest. These periods reflect the known duration of the acute inflammatory phase from wound healing studies (three days) compared to the duration most commonly recommended according to survey data (seven days). Both groups received voice therapy for six weeks after the voice rest periods. Outcomes were assessed with the GRBAS and VHI-10 scales at one, three and six months, as well as with stroboscopic evaluation of the normalised mucosal wave amplitude (NMWA).

The results showed that GRBAS was significantly better in the three-day group at one and three months postoperatively, with no significant difference noted at six months. VHI-10 scores were also better in the three-day group, but the difference was only significant at one month.

NMWA was significantly better in the three-day group at all timepoints measured. While limited by small participant numbers and the apparent absence of assessor blinding, this study does nevertheless provide useful ‘real-life’ clinical data. A prolonged, seven-day period of voice rest appears to be neither necessary nor effective in the context of routine microlaryngoscopy procedures, and may even be detrimental to voice outcomes compared to a shorter, three-day period of voice rest.

Optimal duration for voice rest after vocal fold surgery: randomized controlled clinical study.
Kaneko M, Shiromoto O, Fujiu-Kurachi M, et al.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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