Treatment of Laryngeal Granulomas

Abstract

Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult.

Objective To describe our experience in the treatment of laryngeal granulomas.

Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment.

Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 µg 12/12 hours (1 month), proton pump inhibitor, omeprazole 40 mg/day (2 months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months.

Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.

Keywords

granuloma - larynx - intubation - treatment

• References

• 1 Shoffel-Havakuk H, Halperin D, Yosef L, Feldberg E, Lahav Y. Lesions of the posterior glottis: clinical and pathologic considerations and treatment outcome. J Voice 2014; 28 (02) 263.e1-263.e8
• 2 Martins RH, Dias NH, Santos DC, Fabro AT, Braz JR. Clinical, histological and electron microscopic aspects of vocal fold granulomas. Rev Bras Otorrinolaringol (Engl Ed) 2009; 75 (01) 116-122
• 3 Jin YJ, Lee SJ, Lee WY, Jeong WJ, Ahn SH. Prognostic factors for prediction of follow-up outcome of contact granuloma. Eur Arch Otorhinolaryngol 2014; 271 (07) 1981-1985
• 4 Lesser H, Rutt A, Sataloff RT. Vocal fold granulomas. Ear Nose Throat J 2016; 95 (08) 314
• 5 Storck C, Brockmann M, Zimmermann E, Nekahm-Heis D, Zorowka PG. [Laryngeal granuloma. Aetiology, clinical signs, diagnostic procedures, and treatment]. HNO 2009; 57 (10) 1075-1080
• 6 Lee SW, Hong HJ, Choi SH. , et al. Comparison of treatment modalities for contact granuloma: a nationwide multicenter study. Laryngoscope 2014; 124 (05) 1187-1191
• 7 Mesick ML, Weissbrod PA. Resolution of laryngeal granuloma with high-dose prednisone. Ear Nose Throat J 2014; 93 (4-5): E60-E61
• 8 Hong-Gang D, He-Juan J, Chun-Quan Z, Guo-Kang F. Surgery and proton pump inhibitors for treatment of vocal process granulomas. Eur Arch Otorhinolaryngol 2013; 270 (11) 2921-2926
• 9 Karkos PD, George M, Van Der Veen J. , et al. Vocal process granulomas: a systematic review of treatment. Ann Otol Rhinol Laryngol 2014; 123 (05) 314-320
• 10 Yılmaz T, Kayahan B, Günaydın RÖ, Kuşçu O, Sözen T. Botulinum Toxin A for Treatment of Contact Granuloma. J Voice 2016; 30 (06) 741-743
• 11 Wang CP, Ko JY, Wang YH, Hu YL, Hsiao TY. Vocal process granuloma - A result of long-term observation in 53 patients. Oral Oncol 2009; 45 (09) 821-825
• 12 Ma L, Xiao Y, Ye J, Yang Q, Wang J. Analysis of therapeutic methods for treating vocal process granulomas. Acta Otolaryngol 2015; 135 (03) 277-282
• 13 Yilmaz T, Süslü N, Atay G, Özer S, Günaydin RÖ, Bajin MD. Recurrent contact granuloma: experience with excision and botulinum toxin injection. JAMA Otolaryngol Head Neck Surg 2013; 139 (06) 579-583