Voice rest after microflap for benign lesions (King et al., 2022)

Purpose: Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes.

Method: Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively.

Results: Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point.

Conclusion: VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest.

Supplemental Material S1. Recommended voice rest duration for all patients.

Supplemental Material S2. Comparison of effects of recommended voice rest and timepoint relative to microflap surgery on VHI scores with absolute voice rest duration analyzed categorically or continuously.

Supplemental Material S3. Change in VHI Functional score before and after microflap surgery for benign vocal fold lesions by days of recommended absolute postoperative voice rest.

Supplemental Material S4. Results of exploratory analyses.

King, R. E., Novaleski, C. K., & Rousseau, B. (2022). Voice Handicap Index changes after microflap surgery for benign vocal fold lesions are not associated with recommended absolute voice rest duration. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-21-00115