What is the recommended treatment approach for an adult female with a polyp on the larynx?

Treatment of Laryngeal Polyp in Adult Female

Voice therapy with a certified speech-language pathologist should be the first-line treatment for laryngeal polyps in adult females, with surgery reserved only for cases that fail to achieve satisfactory voice outcomes after an adequate trial of conservative management. 1, 2

Initial Conservative Management Approach

All patients with benign vocal fold polyps should begin with conservative therapy before considering surgical intervention. 1, 2 The American Academy of Otolaryngology-Head and Neck Surgery explicitly states that surgery is reserved for benign vocal fold lesions only when satisfactory voice results cannot be achieved with conservative management and when voice may be improved with surgical intervention. 1

Voice Therapy Protocol

• Therapy consists of 1-2 sessions per week for 4-8 weeks, delivered by a certified and licensed speech-language pathologist. 1, 3
• The primary goals are to eliminate harmful vocal behaviors, shape healthy vocal behavior patterns, and assist in vocal fold wound healing. 1, 2, 3
• Voice therapy is effective across the lifespan and specifically targets phonotraumatic lesions like polyps. 1

Essential Adjunctive Measures

• Adequate hydration to maintain vocal fold health. 2, 3
• Complete avoidance of tobacco and alcohol, which are vocal irritants. 2, 3
• Reduction of excessive musculoskeletal tension in the head, neck, shoulders, face, and mouth. 3
• Treatment of underlying conditions such as laryngopharyngeal reflux or asthma if present. 1

Predictors of Success with Conservative Treatment

Female sex and smaller polyp size are the strongest predictors of successful resolution with voice therapy alone. 4 In a cohort of 92 patients, female patients (54.9%) and those with small polyps (56.1%) showed good response to voice therapy, with multivariate analysis confirming female sex (OR = 0.34) and small size (OR = 0.15) as significant predictors. 4

• Sessile-type polyps respond better than pedunculated types in the small polyp category. 4
• At least 9.7% of vocal fold polyps resolve without surgery, with some studies showing up to 60-80% avoiding surgery with specific voice therapy techniques. 5, 6, 7
• Recent-onset polyps (shorter symptom duration) are more likely to resolve with conservative treatment. 7

Surgical Indications

Surgery should be considered only after failure of an adequate trial of voice therapy (minimum 4-8 weeks with committed patient participation). 1, 2, 3

Specific Indications for Surgery:

• Persistent voice-related quality of life impairment despite 4-8 weeks of committed voice therapy participation. 1, 3
• Inability to achieve satisfactory voice results with conservative management. 1, 2
• Large polyps in male patients (less likely to respond to conservative therapy). 4

Surgical Approach When Indicated:

• Microsurgical excision is the standard surgical approach when conservative management fails. 1
• Voice therapy should be continued postoperatively to prevent recurrence, as failure to address underlying vocal behaviors leads to lesion recurrence. 1

Critical Pitfalls to Avoid

Do not proceed directly to surgery without an adequate trial of conservative management (minimum 4-8 weeks), as many polyps are self-limited or reversible. 1, 2, 3 The guidelines explicitly state that many benign phonotraumatic vocal fold lesions, including polyps, are self-limited or reversible. 1

Do not prescribe antibiotics or corticosteroids empirically for laryngeal polyps, as they are not effective and can delay appropriate treatment. 2

Do not treat empirically without laryngoscopic visualization if hoarseness persists beyond 2 weeks, as this can lead to delayed diagnosis of malignancy. 2 While polyps are typically benign, patients over 60 with tobacco use history have a 28% malignancy rate after excluding self-limited disease. 2

Ensure patient commitment to voice therapy participation, as the success of conservative management depends heavily on patient adherence to vocal hygiene and therapy exercises. 1, 3

Algorithm Summary

1. Confirm diagnosis with laryngoscopy (required for any hoarseness >2 weeks). 2
2. Initiate voice therapy with certified SLP for 4-8 weeks (1-2 sessions/week). 1, 3
3. Implement vocal hygiene measures (hydration, avoid tobacco/alcohol, reduce tension). 2, 3
4. Reassess after adequate trial: If satisfactory voice achieved, continue conservative management; if not, proceed to microsurgical excision. 1
5. Continue voice therapy postoperatively if surgery performed, to prevent recurrence. 1