First-line treatment of exudative vocal fold-lesions by in-office local corticosteroid injection: A literature review

• Published in: European annals of otorhinolaryngology, head and neck diseases Vol. 138; no. 3; pp. 169 - 175
• Main Authors: Dassé, R., De Monès del Pujol, E.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-05-2021
• Subjects: Corticosteroid injection; Exudative vocal-fold lesions; In-office procedure; Reinke's edema; Vocal nodule; Vocal polyp; Exudative vocal-fold lesions; Reinke's edema; In-office procedure; Vocal nodule; Vocal polyp; Corticosteroid injection
• ISSN: 1879-7296; 1879-730X
• DOI: 10.1016/j.anorl.2020.09.001

There are emerging reports of the effectiveness of in-office awake vocal-fold corticosteroid injection in the treatment of exudative vocal-fold lesions. The aim of this study was to review this therapy and specify indications, practical modalities and outcomes.
Systematic review of the literature without meta-analysis.
A systematic review by PubMed search for the period January 2000 to December 2018 was carried out.
Nine articles were included, for a total of 502 lesions: nodules (46.4%), polyps (31.7%), and Reinke's edema (21.9%). Submucosal injection of low-dose triamcinolone acetonide (0.1 to 0.3mL) was transoral, transcutaneous or transnasal via flexible endoscope with operating channel. Lesion volume was significantly reduced in more than 90% of cases, with significant vocal improvement in all studies. Relapse rates ranged between 4% and 31%, with time to relapse of 1 to 40 months.
First-line treatment of exudative glottic lesions by submucosal corticosteroid injection provides at least transient significant reduction in lesion volume and vocal improvement. It is consensually reserved to moderate-sized mainly exudative lesions without fibrosis. In-office injection provides an immediate therapeutic response in case of vocal impairment, enabling surgery under general anesthesia to be postponed.