Clinical Significance of Contralateral Reactive Lesion in Vocal Fold Polyp and Cyst.

OBJECTIVE: We investigated the clinical significance of contralateral reactive lesions in patients undergoing laryngeal microsurgery for benign vocal fold lesions such as vocal polyps and cysts.

STUDY DESIGN: This was a retrospective, single institution cohort study.

METHODS: Patient medical records were reviewed for demographic characteristics; acoustic, aerodynamic, and perceptual analyses; and Voice Handicap Index score before and after laryngeal microsurgery. Definitive diagnoses were made via intraoperative microlaryngoscopic evaluations. Clinical parameters were assessed to identify risk factors for contralateral reactive lesions. We evaluated surgical outcome using voice analysis.

RESULTS: We enrolled 268 patients (109 men and 159 women) with benign vocal fold lesions. A total of 195 (72.8%) had a contralateral reactive vocal fold lesion. A multivariable analysis revealed that being a never smoker and having a hoarseness duration ≥6 months, vocal polyps, and small primary lesions were independent risk factors for contralateral reactive lesions (P <0.05). The preoperative perceptual evaluation and maximum phonation time were significantly worse in patients with a contralateral reactive lesion than in those without one (P = 0.014, P = 0.004, respectively). The voice parameters in patients who underwent excision of the contralateral reactive lesion were generally better than those who received conservative treatment, particularly the noise-to-harmonic ratio (P = 0.004).

CONCLUSIONS: Contralateral reactive vocal fold lesions are frequently detected in patients with vocal polyp and cyst. The reactive lesions had an adverse effect on voice quality. Simultaneous excision of primary and contralateral reactive lesions may be an alternative treatment for better voice outcome.