Patient Characteristics Associated With Treatment Decisions in Bilateral Vocal Fold Atrophy

Bilateral vocal fold atrophy (BVFA) can lead to dysphonia and impact quality of life. Prior studies have evaluated decision-making in dysphonia treatment based on specific diagnoses (vocal fold paralysis) or results of objective testing. As BVFA prevalence rises with population aging, factors influencing patients' treatment decisions remain unclear. The objective of this study is to explore intake-level patient characteristics associated with treatment selection in BVFA.

Retrospective chart review. Patients with BVFA on videostroboscopy from a tertiary academic hospital were identified from 2015 to 2024. Univariable logistic regression analysis was performed to identify patient characteristics associated with the decision to pursue observation, voice therapy, or procedural intervention.

248 patients with VFA were included. Comparing voice therapy versus observation, patients with higher Voice Handicap Index-10 (VHI-10) (OR = 1.06, p = 0.009) or professional voice use (OR = 6.46, p < 0.001) were more likely to pursue voice therapy, while dysphagia (OR = 0.37, p = 0.011) was negatively associated. In the surgical versus nonsurgical model, prior intubation (OR = 26.47, p < 0.001), prior voice therapy (OR = 7.85, p < 0.001), laryngeal trauma (OR = 6.44, p = 0.005), and cardiac disease (OR = 3.59, p = 0.045) were associated with surgical intervention. Current alcohol use was also associated with surgical selection (p = 0.033).

This study identified patient characteristics associated with treatment choice in vocal fold atrophy. These exploratory findings provide a basis for patients and clinicians to consider in decision-making for treatment of vocal fold atrophy.