Abstract
This retrospective cohort study evaluated the clinical efficacy of voice therapy, surgery, and a combination of voice therapy and surgery on the treatment of vocal cord nodules. Ninety-five patients have been assessed, and the results were measured using multidimensional voice measurement tools, such as the Voice Handicap Index (VHI), acoustic features, or recurrence rate. The sample included 95 adults (mean age 38.2 years, 75.8 years female) with bilateral nodules of the middle-membranous vocal fold that were proven with videolaryngostroboscopy. Between 2020 and 2024, the patients were stratified into three treatment arms, namely voice therapy (n=48), surgery (n=12), and a combination of both (n=35). Pre-intervention and post-intervention assessments (3 months, 1 year, and 5 years) were made to evaluate VHI-30 scores, GRBAS perceptual ratings, acoustic measures (jitter, shimmer, maximum phonation time using Praat), and stroboscopic recurrence. Paired t-tests, chi-square tests, and logistic regression (SPSS v26; p < 0.05) were used as statistical tests. The sustained remission in hard nodules was higher in the combined modality (82.9). The total VHI scores improved (83.2 to 36.6, p 0.001). Jitter reduced to 0.9 2.8 (p 0.001) and maximum phonation time increased (12.5 21.3 2). At 5 years follow-up, 76.3% (n=76) of the patients were able to sustain an improvement. The evidence suggests that voice therapy is a better intervention strategy as the initial line of therapy to use in treating soft nodules, and the combined modality is the best in treating mature lesions, thus minimizing surgical intervention and preventing the recurrence by increasing adherence. These results support the stratified treatment approaches, emphasizing treating by behavioral means, guide clinical practice of voice professionals, and establish the basis of future research, including aerodynamic and cost-effective endpoints.