Surgical Excision for Vocal Scar: Assessing Patient Outcomes

Introduction: The diagnosis and treatment of vocal scar presents significant challenges, as there is currently no established gold standard for intervention. Surgical excision of vocal scar is performed at our institution, but has yet to be reported. This study aims to describe the effect of surgery on vocal scar by providing vocal scar categorization with associated voice outcomes.

Methods: All patients with a diagnosis of vocal fold scar who underwent operative vocal scar excision at a single center from 2013-2023 were evaluated. Patients with less than 6 months of follow-up were excluded. Pre and postoperative subjective Voice Handicap Index (VHI-10), and videostroboscopy amplitude and mucosal wave were analyzed using the Voice Vibratory Assessment with Laryngeal Imaging (VALI). These measures were compared via Wilcoxon Signed Rank Test.

Results: A total of 18 patients met inclusion criteria, undergoing 19 surgeries for vocal fold scar excision. The mean age was 48.6 years of age at time of surgery. In terms of classification, 9/19 scars were at the level of epithelium, 7/19 at the level of the lamina propria, 3/19 at the level of the ligament. There was a clinically significant decrease in VHI-10 scores at 6 months follow-up compared to preoperative VHI-10 scores (median -5.83, p < 0.05). Vocal cord vibratory patterns improved across all categories at 3-6 month follow-up, but these changes were not statistically significant.

Conclusions: Surgical excision of vocal scar is associated with clinical long-term improvement. This study is among the first of our knowledge to describe the success of surgical excision for the challenging treatment of vocal scar. Further prospective studies are needed to elucidate the patient factors associated with long-term improvement.