Effectiveness of Vocal Hygiene Advice in Managing Hemorrhagic Vocal Fold Polyps of Varying Sizes

BACKGROUND: Vocal fold (VF) polyps are among the most common minimal associated pathological lesions (MAPLs), typically resulting from voice misuse or abuse. Clinically, they present with dysphonia and may be accompanied by vocal fatigue. VF polyps can be classified histologically into hemorrhagic (telangiectatic), fibrous, mixed, or hyaline types. Hemorrhagic polyps, in particular, are often acute in onset and typically appear reddish during laryngeal examination due to their rich vascularity. While surgical excision has traditionally been the standard treatment, conservative approaches-such as vocal hygiene advice (VHA) and voice therapy (VT)-have emerged as viable alternatives, particularly for small-sized polyps. However, the influence of polyp size on the efficacy of these nonsurgical treatments remains unclear and warrants further investigation.

METHODS: This retrospective observational study was conducted on 35 patients at a tertiary care hospital to evaluate the effectiveness of various therapeutic approaches for hemorrhagic vocal fold polyps. A comprehensive chart review was undertaken, encompassing patient demographics, occupational voice use, vocal symptoms (including vocal fatigue), pre- and post-treatment laryngeal imaging, treatment modalities, and follow-up outcomes. Patients were classified into three groups based on the intervention received: VHA alone, a combination of VHA and VT, and surgical intervention. The primary outcome was the change in polyp size following treatment, used as an indicator of the effectiveness of nonsurgical approaches (VHA with or without VT) in resolving hemorrhagic polyps of varying sizes. Reduction in polyp size was assessed 4-6weeks after therapy. Laryngeal images were analyzed to document size variations visually. Statistical analyses were conducted to explore associations between initial polyp size and treatment efficacy, as well as the impact of demographic and clinical variables on outcomes.

RESULTS: 85.7% of the studied sample showed improvement. Surgery had a 100% success rate, whereas VHA alone had the lowest improvement rate (66.7%). VHA + VT resulted in higher improvement rates (76.9%) compared to VHA alone. Smaller polyps showed better outcomes with conservative management. No statistically significant factors were identified, possibly due to the small sample size except for smoking that was significantly associated with poorer treatment outcomes.

CONCLUSION: While surgery remains the most effective treatment, VHA + VT offers a viable conservative approach, particularly for smaller polyps. It is advised to combine VT with VHA as VHA alone appears to be the least effective. Further research with a larger sample size is recommended to confirm these findings.