Effects of Different Voice Rest on Vocal Function After Microlaryngeal Surgery: A Systematic Review and Meta-Analysis

Abstract

Objectives: To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration (voice rest for <7 days) or long-duration (≥7 days) voice rest.

Study design: Systematic review and meta-analysis.

Methods: The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta-analysis.

Results: Four RCTs comprising 112 patients were included in the quantitative meta-analysis. Compared with the long-duration voice rest group, the short-duration group exhibited comparable VHI scores (mean difference [MD], -7.01; 95% CI, -16.12 to 2.09; p = 0.13), maximum phonation time (MD, -2.58; 95% CI, -5.42 to 0.26; p = 0.07), and acoustic variables of jitter (MD, -1.25; 95% CI, -3.43 to 0.94; p = 0.26) and shimmer (MD, -0.79; 95% CI, -2.08 to 0.51; p = 0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, -14.45; 95% CI, -26.19 to -2.72; p = 0.02 and MD, -15.98; 95% CI, -28.52 to -3.44; p = 0.01, respectively) in the short-duration group.

Conclusions: The limited evidence does not demonstrate benefit in voice outcomes from long-duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short-duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest.

Level of evidence: 1 Laryngoscope, 133:154-161, 2023.

Keywords: Voice Handicap Index; jitter; maximum phonation time; microlaryngeal surgery; shimmer; voice rest.