Percutaneous vocal fold steroid injections: a current reappraisal of indications and techniques

Vocal fold steroid injections have been proposed for benign lesions (e.g. vocal nodules, polyps, cysts and Reinke's edema), based on their inflammatory background. Although several studies reported the trans-nasal fiber-endoscopic techniques, evidence regarding transcervical percutaneous approaches is limited. This review aimed to critically analyze the available evidence on percutaneous steroid injections for benign laryngeal lesions, providing an updated summary of indications, surgical techniques and results.

The Pubmed and Scopus databases were searched, according to the following keywords: percutaneous AND (steroid OR corticosteroid) AND injection AND (larynx OR laryngeal OR vocal fold). Articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Original reports, in English, describing treatment with percutaneous vocal fold steroid injection were included. Articles lacking relevant reported data, single case reports, non-original studies, or preclinical studies were excluded.

603 papers were retrieved. After duplicates removal and exclusion of studies not complying with the inclusion/exclusion criteria, 16 articles were included. The treated benign lesions were pre-nodular swelling/nodules, polyps, granulomas, fibrosis/scars, laryngeal stenosis and Reinke's edema. The described percutaneous approaches included the trans-thyrohyoid, trans-cricothyroid and trans-thyroid cartilage routes.

The available evidence describes percutaneous vocal fold steroid injection as feasible and effective in benign laryngeal lesions. In terms of clinical effectiveness, nodules and polyps seemed to show potentially more benefit compared to other lesion types. However, the heterogeneity of the available studies may prevent generalizability. To obtain more conclusive data, further studies, preferably in a prospective multicenter setting, are advocated.