Steroid Injection in Patients With Benign Vocal Fold Lesions: A Meta-Analysis and Meta-Regression

This study aims to assess the efficacy and safety of steroid injections in patients with benign vocal fold lesions.

PubMed, Scopus, and Embase were searched from January 2000 through December 2025 using predefined terms for benign vocal fold pathology and steroid injection.

We conducted a PRISMA-guided systematic review and meta-analysis of studies evaluating steroid injections for benign vocal fold lesions. Study selection and data extraction were performed independently by two reviewers. Study quality was assessed using NIH (cohort studies), JBI (case series), and RoB 2 (RCTs). Random-effects meta-analysis (DerSimonian-Laird) was performed in OpenMeta[Analyst], with Freeman-Tukey double arcsine transformation for proportional outcomes.

Fourteen studies were included. Posttreatment VHI pooled mean was 17.585 (95% CI 10.61-24.55; I ² = 97%), while VHI change was not statistically significant (-6.948; 95% CI -16.06 to 2.16; I ² = 98%), indicating substantial between-study heterogeneity and limited certainty in pooled VHI effect estimates. MPT improved, with post-treatment pooled mean 13.24 seconds (95% CI 12.54-13.94; I ² = 73%) and pooled change 1.81 seconds (95% CI 1.10-2.52; I ² = 71%). Complications were uncommon (1.5%; I ² = 0%). Overall improvement was 92%, recurrence 15.2%, complete remission 42.5%, partial remission 39.6%, and no response 9.4%.

Steroid injection was associated with high clinical improvement and low complication rates. However, VHI demonstrated substantial heterogeneity and inconsistent statistical significance across studies, limiting the robustness and generalizability of pooled quality-of-life estimates. These findings support steroid injection as a minimally invasive option in selected patients but highlight the need for standardized protocols and higher-quality comparative trials to better define its effect on patient-reported voice outcomes.