Phonosurgery for vocal fold polyps: A comprehensive analysis of multidimensional voice outcomes in 201 cases and the impact of polyp size.

[OBJECTIVE] To elucidate the clinical characteristics of vocal fold polyps (VFPs) and evaluate the efficacy of phonosurgery using a comprehensive analysis of multidimensional voice parameters.

[METHODS] We conducted a retrospective review of 201 patients with VFPs treated at Kurume University Hospital between 1996 and 2022. All patients underwent either endolaryngeal microsurgery (LMS) under general anesthesia or forceps excision (FE) under local anesthesia. Lesions were categorized as pedunculated or sessile and as hemorrhagic or non-hemorrhagic based on coloration. Polyp size was calculated as the ratio of the lesion diameter to the distance from the anterior commissure to the vocal process. Pre- and postoperative values and postoperative differences (Δ) were analyzed for voice parameters: maximum phonation time (MPT), mean flow rate (MFR), fundamental frequency (F), F range, sound pressure level (SPL), SPL range, pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), jitter, shimmer, normalized noise energy (NNEa), noise-to-harmonic ratio, Voice Handicap Index-10 (VHI-10), Voice-Related Quality of Life (V-RQOL), and GRB scale (G = grade, R = roughness, B = breathiness). Outcomes between LMS and FE were compared using adjusted analyses to control for baseline differences.

[RESULTS] Men were significantly older than women (p = 0.034) and had larger polyps (p = 0.005) that were more often pedunculated (p = 0.006) and hemorrhagic (p = 0.031); bilateral lesions were more common in women (p = 0.040). Except for F and SPL, all multidimensional voice parameters improved significantly after surgery. Comparing surgical approaches, the LMS group (n = 166) was younger (p = 0.003) and had larger polyps (p < 0.001) than the FE group (n = 35). After adjusting for age and polyp size, most voice parameters showed no significant difference between LMS and FE. Polyp size was weakly to moderately correlated with multiple preoperative parameters; it correlated positively with MFR in men (p = 0.025), PPQ (p = 0.032), APQ (p = 0.003), jitter (p = 0.027), shimmer (p = 0.001), NNEa (p = 0.004), VHI‑10 (p = 0.030), G (p = 0.001), R (p = 0.006), and B (p = 0.006) and negatively with MPT (p = 0.012) and F range in men (p = 0.015). Larger polyps also showed weak negative correlations with ΔAPQ (p = 0.029), Δjitter (p = 0.009), Δshimmer (p = 0.047), ΔVHI-10 (p = 0.037), ΔG (p = 0.005), ΔR (p = 0.031), and ΔB (p = 0.005).

[CONCLUSION] Phonosurgery for VFPs significantly improves multidimensional voice outcomes. Polyp size is a contributing factor to the degree of preoperative vocal impairment and the magnitude of postoperative recovery. After adjustment, FE provided comparable voice outcomes to LMS, confirming its role as a valuable therapeutic alternative for patients who are not candidates for LMS.