Transnasal endoscopic steroid injection: A practical and effective alternative treatment for benign vocal fold disorders

Abstract

OBJECTIVES/HYPOTHESIS: Emerging literature has documented the effectiveness of intralesional steroid injection as an alternative treatment for benign vocal fold disorders. However, clinical application is frequently limited by the associated technical demands for adequate anesthesia and precise needle placement. This study investigated the applicability and effectiveness of the more practical and less technically demanding method of transnasal endoscopic steroid injection (TESI). STUDY DESIGN: Prospective case series. METHODS: This study recruited 30 patients with vocal nodules and polyps. Dexamethasone was injected into the Reinke's space under local anesthesia via the operating channel of a transnasal flexible laryngoscope in an office setting. Treatment outcome were measured before, 1 month after, and 3 months after the injection, using videolaryngostroboscopy (VLS), maximal phonation time (MPT), 10-item voice handicap index (VHI-10), acoustic analysis, and perceptual evaluation. RESULTS: VLS examinations at 3 months post-treatment demonstrated that vocal lesions of 10 and 19 patients were resolved or reduced, respectively. Objective measurements showed increased MPT and decreased VHI-10 (P < .05 and P < .01, respectively). Acoustic analysis revealed significant decrease in jitter and shimmer (P < .05). Perceptual evaluation using the GRB (grade, roughness, breathiness) scale also showed improved voice quality (P < .01). Treatment outcomes were similar between vocal nodules and polyps (P > .05). Mild vocal hematoma occurred in three patients following TESI, but resolved spontaneously within 1 month. CONCLUSIONS: TESI is a simple and practical office-based treatment modality for benign vocal fold lesions, suitable for most otolaryngologists. Treatment outcomes showed significant subjective and objective improvements that were comparable to the results of other injection procedures reported in the literature. LEVEL OF EVIDENCE: 4.