IMPORTANCE Classically, surgery has been the mainstay of management for vocal fold (VF) polyps. However, a significant portion of patients experience spontaneous regression and may not require surgery. OBJECTIVES To report the results of conservative management for VF polyps, identify patients with polyps that are more likely to resolve, and describe the time course of resolution. DESIGN, SETTING, AND PARTICIPANTS In this case series of 248 patients with VF polyps conducted presenting to a tertiary referral center, 94 patients were treated conservatively with at least 3 months of follow-up. All laryngoscopy photodocumentation and medical records were reviewed retrospectively. INTERVENTIONS Conservative management with close follow-up. MAIN OUTCOMES AND MEASURES Time course and resolution of VF polyps. RESULTS Of 94 VF polyps, 43 (46%) showed a clinically significant reduction in size, and 36 (38%) resolved completely without requiring surgery. Multivariate analysis showed that VF polyps were most likely to resolve in female patients and in those with small-sized polyp and shorter symptom duration. Of the resolved polyps, 44% and 81% were resolved at 3 months and 8 months, respectively. CONCLUSIONS AND RELEVANCE Selected patients with VF polyp may benefit from conservative management, especially female patients and those with small, recent-onset polyps. The majority of polyps that resolve do so within 8 months, which can assist clinical decision making and counseling.