Is Postoperative Voice Rest Unnecessary? A Systematic Review and Meta-analysis of Voice Rest Recommendation Outcomes.

Background: Voice rest (VR) is widely recommended after microlaryngeal surgery to facilitate recovery and improve voice outcomes. Our study is the first systematic review and meta-analysis summarizing the impact of postoperative absolute voice rest (AVR) and no voice rest (NVR) instructions on voice outcomes.

Methods: PubMed, Embase, and Cochrane Library databases were searched using "voice rest laryngeal surgery" and "postoperative voice rest" for articles published before December 2022. Risk of bias was assessed using ROBINS-I and RoB2 tools. Meta-analysis using a random effects model was performed for studies comparing Voice Handicap Index (VHI-10) outcomes between NVR and AVR. Analysis was performed in R Studio.

Results: In total, 255 articles were reviewed, 24 underwent full-text screening, and nine met inclusion criteria. Four randomized control trials (RCT) and one retrospective review compared AVR durations (range: 2-10days). Four studies (two cohort, one cross-sectional, and one RCT) compared AVR to NVR. All studies had risk of bias (ROBINS-I: two moderate, two serious; RoB2: five with concerns). Comparing AVR durations, two found no difference between short and long duration, while two reported improved outcomes for the short cohort. In studies comparing AVR to NVR, all concluded no significant difference in outcomes. Pooled analysis of three studies (355 patients) comparing NVR and AVR demonstrated no significant differences in pre- and postoperative VHI-10 change (mean difference=-0.87; 95% CI, -2.51 to 0.77; P = 0.27).

Conclusion: Systematic review findings indicate postoperative VR may not lead to improved voice outcomes, and a meta-analysis demonstrated no difference in VHI-10 outcomes between AVR and NVR.

Level of evidence: 2: