양성 성대 병변에 대한 성대내 스테로이드 주사치료

Abstract

Voice therapy and laryngeal microsurgery are the main treatment options for benign vocal fold lesions. However, if patients are unable to endure lengthy voice therapy, or refuse surgery under general anesthesia, clinicians need to try other methods. Recently local steroid injection directly into the true vocal folds (TVF) benign lesions has been focused on alternative treatment options, and good results have been reported. Local steroid injection into the TVF was first described in 1964 by Dr. Yanagihara. Although this initial technique was inaccurate, however, with the advancement of modern endoscopy, recent emerging articles have proposed for the effectiveness of in-office awake vocal fold steroid injection in the treatment of benign vocal fold lesions. Based on previous studies of vocal fold steroid injection in the treatment of benign vocal fold lesions, I will summarize and suggest as follows. Various corticosteroids (triamcinolone acetonide, methylprednisolone, dexamethasone sodium phosphate) are used for the intralesional injection in the treatment of benign vocal fold lesions. The steroid injection approach can be transoral, transcutaneous or via flexible endoscope with operating channel, and injection route depends mainly on availability and individual experience. Intralesional corticosteroid injection significantly reduces benign vocal fold lesion volume and improves voice quality, at least transiently. There are many unresolved issues remain regarding the problem of vocal fold atrophy after steroid injection. Nevertheless, to minimize the risk of vocal atrophy, it is advisable to pay attention to repeating short interval steroid injection or administrating high dose of steroid. And, in case where repeated steroid injections are necessary for benign vocal fold lesions such as vocal nodule, vocal polyp, Reinke’s edema, I suggest that 12 weeks intervals would be safe to prevent vocal fold atrophy. And, to prevent recurrence of benign vocal fold lesions after steroid injection therapy, it is recommended to add post-procedural voice therapy, including vocal hygiene.