Factors Associated With Improvement Following In-office Steroid Injections for Vocal Fold Scar.

Area of Science:

• Otolaryngology
• Speech-Language Pathology
• Vocal Health

Background:

• Vocal fold scar can significantly impair voice quality and function.
• In-office vocal fold steroid injections (VFSI) are an emerging treatment option.
• Evaluating clinical outcomes and novel acoustic measures is crucial for understanding VFSI efficacy.

Purpose of the Study:

• To assess the clinical outcomes of in-office vocal fold steroid injections (VFSI) in patients with vocal fold scar.
• To investigate the impact of VFSI on voice quality using the Voice Handicap Index (VHI-10) and acoustic parameters like cepstral peak prominence (CPP) and fundamental frequency coefficient of variation (F0CoV).
• To explore the relationship between patient characteristics and treatment success.

Main Methods:

• Retrospective analysis of 22 patients with vocal fold scar receiving in-office VFSI between 2013 and 2024.
• Comparison of pre- and post-injection VHI-10 scores, stroboscopic vibratory parameters (mucosal wave, amplitude), and acoustic measures (CPP, F0CoV).
• Statistical analysis using Wilcoxon signed-rank and McNemar's tests to determine significance.

Main Results:

• A median decrease of 4 points in VHI-10 was observed post-injection (p=0.02).
• 45% of patients showed improvement in mucosal wave and/or amplitude; earlier vocal injury presentation correlated with improved left vocal fold vibratory parameters (p=0.03).
• No significant changes were found in CPP or F0CoV; no baseline characteristics predicted vibratory improvement.

Conclusions:

• In-office VFSI provides modest voice use improvement for vocal fold scar patients, potentially less impactful than previously assumed.
• Videostroboscopic improvement is observed in approximately half of the patients.
• Recency of vocal injury is a potential predictor of success, aiding in patient counseling regarding VFSI benefits.