Medical Student Cleveland Clinic Lerner College of Medicine Cleveland, Ohio
Introduction: Pediatric vocal fold lesions (pVFL) are often treated conservatively with voice therapy, but voice changes may persist. Surgical treatment for pVFL is controversial. This systematic review and meta-analysis aims to evaluate the outcomes of surgical treatment of pVFL and implications for management.
Methods: PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science were searched from inception to May 2021 using PRISMA guidelines. Studies analyzing outcomes of surgically treated pVFL were included. Non-English studies and case reports were excluded. Outcomes included improvement in dysphonia, hoarseness, overall voice, and recurrence. Two evaluators independently reviewed each abstract and article. Heterogeneity and bias across studies were evaluated and meta-analysis was performed to estimate improvement in dysphonia.
Results: Of 655 articles identified, 11 met inclusion criteria. There were 382 children with age range of 0-18 years and male-to-female ratio of 2.7:1. There were 311 (81.4%) vocal fold nodules, 35 (9.2%) cysts, 17 (4.5%) sulcus vocalis, 8 (2.1%) laryngeal hemangiomas and 1 (0.3%) mucosal bridge surgically treated. The most common symptoms were hoarseness, voice loss, vocal fatigue, and stridor. Microsurgery was performed in all studies, with one study employing CO2 laser vaporization. There were no reported surgical complications. Follow-up (range 10 days-13 years) consisted of postoperative questionnaire, stroboscopy, and acoustic analysis. One study (n=19) concluded that neither surgery nor voice therapy was effective for pVFL, and the remaining 10 studies concluded that symptoms improved following surgery based on perceptual evaluation of voice. Auditory perceptual parameters improved in 2 studies. Meta-analysis of 8 studies demonstrated improvement in dysphonia in 86.7% of children after surgery (95% CI: 70.6-97.0%). There was recurrence of pVFL in 64 of 228 (28.1%) children (3 studies).
Conclusion: Surgical treatment can be an effective intervention for pVFL. Relative efficacy compared to non-operative intervention was sparsely reported, but some studies suggested surgery as a faster and more reliable method of attaining improvement. Microsurgery can be considered for pediatric patients with persistent dysphonia or severe vocal symptoms.