Recurrence of Benign Vocal Fold Lesions: Risk Factors and an Exploratory Comparison of Cold-Instrument and CO2 Laser Surgery in a Retrospective Cohort

Background and Objectives: Benign vocal fold lesions (BVFLs) are common causes of persistent dysphonia, but recurrence estimates are influenced by lesion type, outcome definition, and follow-up. We evaluated recurrence after documented lesion resolution and explored clinical factors and surgical technique. Materials and Methods: We performed a single-center retrospective cohort study of 214 adults with a first documented BVFL diagnosis between January 2022 and December 2024. Clinical records were reviewed through January 2026. Recurrence was defined as lesion reappearance after documented resolution at the initial post-treatment laryngeal assessment; persistent lesions were classified separately. Results: Follow-up was documented in 142 patients (66.4%). Initial lesion resolution was documented in 135 patients, of whom 23 developed recurrence (17.0%); 7 patients had persistent disease at the initial post-treatment assessment. No evaluated demographic or clinical factor was significantly associated with recurrence in univariate analyses. In the secondary exploratory surgical analysis, recurrence occurred in 7/29 patients treated with cold instruments (24.1%) and 3/27 treated with CO2 laser (11.1%; OR 2.55, 95% CI 0.58–11.08; Fisher exact p = 0.299). Conclusions: Documented recurrence after initial lesion resolution occurred in 17.0% of patients. The surgical technique comparison was underpowered and unadjusted and does not establish superiority of either technique. Variable follow-up and differential attrition should be considered when interpreting the recurrence proportion.