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Assessing the utility of non-surgical treatments in the management of vocal process granulomas

Published online by Cambridge University Press:  10 January 2020

J R Rudman ,
C S McGee ,
J Diaz  and
D E Rosow
J R Rudman
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
C S McGee
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
J Diaz
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
D E Rosow*
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
*
Author for correspondence: Dr David E Rosow, Department of Otolaryngology, University of Miami Miller School of Medicine, 5th floor, 1120 NW 14th Street, Miami, FL33136, USA E-mail: drosow@med.miami.edu Fax: +1 305 243 2009
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Abstract

Objective

To determine whether patients would have equivalent or improved outcomes when receiving non-surgical management versus surgical removal for vocal process granulomas.

Methods

A chart review was performed for 53 adults with vocal process granulomas. All patients received baseline anti-reflux treatment consisting of twice-daily proton pump inhibitors and vocal hygiene education. Further treatment approaches were divided into non-surgical (i.e. inhaled corticosteroids, voice therapy, botulinum toxin injections) and surgical groups. Subjective parameters (Voice Handicap Index 10 and Reflux Symptom Index) and outcomes were tabulated and statistically compared. Cause of granuloma was also analysed to determine if this influenced outcomes.

Results

Of 53 patients, 47 (89 per cent) experienced reduction in granuloma size, while 37 (70 per cent) experienced complete resolution. The rate of complete granuloma resolution after initial treatment strategy alone was significantly higher in non-surgical compared to surgical patients (67 and 30 per cent, respectively; p = 0.039). No difference in outcome was seen between iatrogenic and idiopathic granulomas.

Conclusion

Non-surgical patients were more likely to experience initial treatment success than those who underwent surgical removal. Continued emphasis should be placed on conservative treatment options prior to surgery for patients with this condition.

Keywords

Vocal CordsArytenoid CartilageLaryngeal GranulomaTreatment Outcome
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 1 , January 2020 , pp. 68 - 73
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Dr D E Rosow takes responsibility for the integrity of the content of the paper

Presented at the Fall Voice Conference, 12–14 October 2017, Pentagon City, Washington, DC, USA.

References

Jackson, C. Contact ulcer of the larynx. Ann Otol Rhinol Laryngol 1928;37:228–3010.1177/000348942803700117CrossRefGoogle Scholar
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;45:821–510.1016/j.oraloncology.2009.01.008CrossRefGoogle ScholarPubMed
Havas, TE, Priestley, J, Lowinger, DS. A management strategy for vocal process granulomas. Laryngoscope 1999;109:301–610.1097/00005537-199902000-00023CrossRefGoogle ScholarPubMed
Clausen, RL. Unusual sequelae of tracheal intubation. Proc R Soc Med 1932;25:1507Google Scholar
Brodnitz, F. Contact ulcer of the larynx. Arch Otolaryngol Head Neck Surg 1961;74:708010.1001/archotol.1961.00740030073013CrossRefGoogle Scholar
Ylitalo, R, Hammarberg, B. Voice characteristics, effects of voice therapy, and long-term follow-up of contact granuloma patients. J Voice 2000;14:557–6610.1016/S0892-1997(00)80011-9CrossRefGoogle ScholarPubMed
Karkos, PD, George, M, Van Der Veen, J, Atkinson, H, Dwivedi, RC, Kim, D et al. Vocal process granulomas: a systematic review of treatment. Ann Otol Rhinol Laryngol 2014;123:314–2010.1177/0003489414525921CrossRefGoogle ScholarPubMed
Hillel, AT, Lin, LM, Samlan, R, Starmer, H, Leahy, K, Flint, PW. Inhaled triamcinolone with proton pump inhibitor for treatment of vocal process granulomas: a series of 67 granulomas. Ann Otol Rhinol Laryngol 2010;119:325–3010.1177/000348941011900509CrossRefGoogle ScholarPubMed
Wang, CT, Lai, MS, Hsiao, TY. Comprehensive outcome researches of intralesional steroid injection on benign vocal fold lesions. J Voice 2015;29:578–8710.1016/j.jvoice.2014.11.002CrossRefGoogle ScholarPubMed
Nasri, S, Sercarz, JA, McAlpin, T, Berke, GS. Treatment of vocal fold granuloma using botulinum toxin type A. Laryngoscope 1995;105:585–810.1288/00005537-199506000-00005CrossRefGoogle ScholarPubMed
Yilmaz, T, Kayahan, B, Gunaydin, RO, Kuscu, O, Sozen, T. Botulinum toxin A for treatment of contact granuloma. J Voice 2016;30:741–310.1016/j.jvoice.2015.07.015CrossRefGoogle ScholarPubMed
Fink, DS, Achkar, J, Franco, RA, Song, PC. Interarytenoid botulinum toxin injection for recalcitrant vocal process granuloma. Laryngoscope 2013;123:3084–710.1002/lary.23915CrossRefGoogle ScholarPubMed
Song, Y, Shi, L, Zhao, Y, Zhao, D, Shi, M, Deng, Z. Surgical removal followed by radiotherapy for refractory vocal process granuloma. J Voice 2012;26:666.e1–510.1016/j.jvoice.2011.08.004CrossRefGoogle ScholarPubMed
Rosen, CA, Lee, AS, Osborne, J, Zullo, T, Murry, T. Development and validation of the voice handicap index-10. Laryngoscope 2004;114:1549–5610.1097/00005537-200409000-00009CrossRefGoogle ScholarPubMed
Belafsky, PC, Postma, GN, Koufman, JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002;16:274–710.1016/S0892-1997(02)00097-8CrossRefGoogle Scholar
Lei, L, Yang, H, Zhang, X, Ren, J. Comparison of the effects of esomeprazole plus mosapride citrate and botulinum toxin A on vocal process granuloma. Am J Otolaryngol 2017;38:593–710.1016/j.amjoto.2017.01.039CrossRefGoogle ScholarPubMed
Pham, J, Yin, S, Morgan, M, Stucker, F, Nathan, CO. Botulinum toxin: helpful adjunct to early resolution of laryngeal granulomas. J Laryngol Otol 2004;118:781–510.1258/0022215042450788CrossRefGoogle ScholarPubMed
Mascarella, MA, Young, J. In-office excision en masse of a vocal process granuloma using the potassium-titanyl-phosphate laser. J Voice 2016;30:93–510.1016/j.jvoice.2014.12.006CrossRefGoogle ScholarPubMed
Ma, L, Xiao, Y, Ye, J, Yang, Q, Wang, J. Surgical excision and botulinum toxin A injection for vocal process granuloma [in Chinese]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015;29:140–3Google Scholar
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;270:2921–610.1007/s00405-013-2527-8CrossRefGoogle ScholarPubMed
Ylitalo, R, Lindestad, PA. A retrospective study of contact granuloma. Laryngoscope 1999;109:433–610.1097/00005537-199903000-00017CrossRefGoogle ScholarPubMed