# Intralesional steroid injection versus voice therapy for the management of early vocal fold nodules in female patients: a randomized controlled trial

## TL;DR

This study compares steroid injections and voice therapy for vocal fold nodules in women, finding that voice therapy provides better long-term results.

## Contribution

The study provides the first comparative long-term evaluation of intralesional steroid injections versus voice therapy for vocal fold nodules.

## Key findings

- Both steroid injections and voice therapy improved nodule size and vocal function over six months.
- Voice therapy outperformed steroid injections in most measures by the third month and in nodule reduction by six months.
- Steroid injections offer rapid results but may require additional therapy for sustained benefits.

## Abstract

While vocal fold steroid injection (VFSI) is emerging as a therapeutic approach for vocal fold nodules (VFNs), its comparative efficacy relative to standard voice therapy remains unestablished. This study aimed to evaluate and contrast treatment findings between VFSI and voice therapy for VFNs.

In a randomized controlled trial, 50 female patients with VFNs received either percutaneous intralesional triamcinolone injection or Accent method voice therapy. Serial evaluations—including videoendoscopic (nodule size, mucosal wave, glottic gap), subjective (auditory perceptual assessment, Voice Handicap Index), and objective (acoustic, aerodynamic) measures—were conducted at baseline and at 1 week and 1-, 2-, 3-, and 6-months post-treatment.

Both groups demonstrated significant reductions in nodule size and improvements in mucosal wave patterns and glottic gaps over the 6 months (p < 0.05). Most subjective and objective measures also enhanced significantly in both groups over the same study period (p < 0.05). However, voice therapy outperformed VFSI in most parameters (videoendoscopic, subjective, and objective) by the end of the third month (p < 0.05) and in nodule size reduction by the sixth month (p = 0.049).

VFSI is a rapid and reliable therapeutic solution for VFNs with outcomes comparable to voice therapy. Long-term data, however, demonstrate voice therapy better prevents nodule recurrence. Therefore, subsequent voice therapy or repeated injections may enhance the long-term efficacy of VFSI.