| Abstract | Objective: This study aims to assess the clinical suitability and strategies of microsurgical laryngeal surgery in treating vocal cord nodules or polyps in children with persistent moderate to severe hoarseness, for whom conservative treatment has proven ineffective, addressing controversies related to indications, age selection, and optimal timing for surgery.
Methods: This study enrolled pediatric patients aged 6-14 diagnosed with vocal cord polyps at the Department of Otolaryngology, Head and Neck Surgery of West China Hospita. Hoarseness severity was subjectively evaluated by experienced phoniatricians. Voice underwent objective analysis through acoustic measurements, and caregivers completed the pVHI-10 and pVRQOL scales to assess vocal-related quality of life. For treatment, all patients underwent initial voice training with continuous supervision for home exercises. Follow-up exams were conducted 4-6 months later. If conservative treatment was ineffective (determined by laryngoscopy showing an increase in vocal cord polyp size or no clear reduction, coupled with insufficient improvement in hoarseness), microlaryngeal surgery was arranged. Preoperative and postoperative assessments, including laryngoscopy, acoustic voice analysis, and completion of subjective assessments using the pVHI-10 and pVRQOL scales by caregivers, occurred at 1-month and 6-month intervals.
Results: Among the 48 follow-up patients, 33 exhibited no improvement or worsening of hoarseness after conservative treatment, leading to a recommendation for microlaryngeal surgery. 30 patients ultimately underwent microlaryngeal surgery. Before surgery, 63.4%had moderate hoarseness, and 36.7% had severe hoarseness. The median follow-up was 3 months. Paired-sample t-tests revealed significant improvement in voice quality postoperatively. Preoperative pVHI-10 was 29.43±12.21 points,1 month postoperative score was 14.40±9.03 points, and 6 months postoperative score was 16.20±7.03 points (p<0.05). Preoperative pVRQOL score was 95.87±3.38 points,1month postoperative score was 98.84±2.26 points, and 6 months postoperative score was 97.84±2.03 points (p<0.05). Among cases,21 cases howed significant improvement with no recurrence, while 9 cases experienced slight improvement but recurrence, mainly attributed to persistent adverse vocal behavior post-surgery.
Conclusion: Based on our study, microlaryngeal surgery is recommended for children with vocal cord polyps and persistent hoarseness despite 3-6 months of conservative treatment. Use cold instruments, focus on superficial intervention, and preserve normal vocal cord mucosa to minimize damage and protect function. This approach enhances therapeutic outcomes for these patients, providing valuable insights for clinical management.
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