The effect of retinyl palmitate on healing of benign vocal fold lesions

The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.