Symptom Characteristics of Benign Vocal Fold Lesions May Reflect Different Mechanisms of Injury

ABSTRACT Objectives/Hypotheses To compare symptom characteristics between benign vocal fold lesions for insight into pathophysiology. Study Design Cross‐sectional study. Methods Adults who were diagnosed with a benign vocal fold lesion between June 2023 and June 2024 were included. Symptom features including acuity, duration, and inciting event were noted, along with prior history of voice problems, gender, and occupational voice load. Patients with cysts, polyps, and midfold lesions (fibrous mass, pseudocyst, non‐specific midfold mass) were compared to those with lesions known to be acute (edema, hemorrhage) and lesions known to be chronic (sulcus vergeture, sulcus vocalis, scar, Reinke's edema). Results One hundred and fifty‐one adults (44M:106F:1Other; mean age 39.1 ± 15.8 years) were included. Midfold lesions (49.3%) and cysts (53.3%) had similar rates of gradual onset to known chronic lesions (50.0%), whereas polyps (30.4%) and known acute lesions had lower rates (8.3%, Exact Test = 16.6, p = 0.002). Similarly, midfold masses (37.3%), cysts (13.3%), and known chronic lesions (42.9%) had lower associations with an inciting event compared to polyps (52.2%) and known acute lesions (87.5%, Exact Test = 26.8, p < 0.001). While not statistically significant ( p = 0.054), cysts (46.7%), midfold lesions (57.3%), and known chronic lesions (78.6%) had a trend for more prior voice problems compared to polyps (30.4%) and known acute lesions (50.0%). Conclusions These findings are consistent with models of phonotraumatic lesion development that suggest midfold lesions develop as a result of chronic cumulative damage, whereas polyps are more likely to develop acutely. Cysts may be structural lesions, as demonstrated by their lack of association with occupational voice use and chronic nature. Level of Evidence 4.