Comparison between Laryngeal Microsurgery versus Laryngeal Microsurgery with Corticosteroid Injection in the Management of Patients with Minimal Associated Pathological Lesions

Abstract

Background: Minimal Associated Pathological Lesions (MAPLs) are non-neoplastic, non-inflammatory, traumatic lesions of the vocal fold that occupy a position somewhere between the organic benign and non-organic groups and might have been predisposed by long-standing non-organic vocal dysfunction. Methods: This Prospective randomized study was carried out on 30 consecutive candidates with MAPLs. They were categorized into two main groups according to their management, Group A, managed by laryngeal microsurgery (LMS), and Group B, managed by LMS and corticosteroid injection. Under each main group, there were three subgroups according to their primary lesions a subgroup of vocal fold polyps, a subgroup of vocal fold nodules, and another subgroup of vocal fold cysts. All patients were exposed to subjective evaluation by a scale of modified GRBAS (grade, roughness, breathiness, asthenia, strain) and objective evaluation by acoustic parameter and aerodynamically by maximum phonation time (MPT). Results: The acoustic, and aerodynamic parameters, as well as the modified GRBAS scale, showed a significant difference between pre-and post-operative in both groups in the three types of vocal folds (polyp, cyst, and nodules) indicating the effectiveness of both lines of management. The obtained results of the modified GRBAS scale and acoustic and aerodynamic parameters in vocal fold nodules showed a significant variation in the result of both groups pre-operative and post-operative. Conclusions: Steroid injection with laryngeal microsurgery used for the treatment of MAPLs may not cause significant improvement regarding the modified GRBAS scale, acoustic analysis, and aerodynamic measures in short-term assessment over laryngeal microsurgery.