Clinical Characteristics and Voice Handicap Index Assessment of Common Benign Vocal Fold Lesions: A Case-Control Study From a Referral Center Publisher



Azadnajafabad S^{1, 2} ; Mohammadi E² ; Afzal S³ ; Sohrabi H² ; Dabirmoghaddam P¹ ; Aghazadeh K¹ Show Affiliations
Source: Journal of Voice Published:2025

Abstract

Objectives: Benign vocal fold lesions (BVFL) significantly impact patients' quality of life. This study aimed to investigate the characteristics, risk factors, and voice-related impacts among BVFL patients compared with healthy controls and to propose new Voice Handicap Index (VHI) cutoffs for better diagnosis. Study Design: Prospective case-control observational study. Methods: This study was conducted during 2022-2023. The case group included patients aged 18-65 years with dysphonia or related symptoms diagnosed with BVFL via videostroboscopy. The control group comprised individuals without voice disorders. Data collection included demographics, clinical history, and voice-related factors using the VHI questionnaire. Statistical analyses involved summary statistics and statistical tests for categorical and continuous variables, and logistic regression to identify predictors of BVFL. Receiver operating characteristic curve analysis was used to determine the optimal VHI cutoffs. Results: The study included 120 participants (60 BVFL patients, 60 controls), with overall median of age of 44 (Q1-Q3: 36.0, 52.0), and a male dominancy (61.7%). Polyps were the most common BVFL diagnosis (50.0%), followed by nodules (30.0%), cysts (15.0%), and granulomas (5.0%). BVFL patients had significantly higher total VHI scores (median 47, 35.8-59.0) compared with controls (median 11, Q1-Q3: 8.0-13.3). Multivariable logistic regression identified laryngopharyngeal reflux (LPR) (adjusted OR: 2.83, 95% CI: 1.20-6.89), severe talkativeness (adjusted OR: 3.99, 95% CI: 1.34-12.79), and high voice loudness (adjusted OR: 3.60, 95% CI: 1.11-12.77) as significant predictors. The optimal VHI cutoff to differentiate BVFL patients from controls was 17.5, with 96.7% sensitivity and 98.3% specificity. Conclusions: The study identifies key clinical and lifestyle factors associated with BVFL, emphasizing the importance of addressing modifiable risk factors like LPR, talkativeness, and voice loudness. The proposed VHI cutoffs improve diagnostic accuracy, facilitating better clinical assessment and management of BVFL patients, while considering it as complementary to clinical factors and assessments. © 2025 The Voice Foundation