Comparison of the Effects of Botulinum Toxin A Injection and Local Glucocorticoid Injection for Treating Laryngeal Contact Granuloma

The effectiveness of various treatment approaches for laryngeal contact granulomas

OBJECTIVES

To assess and compare the effectiveness of various treatment approaches for laryngeal contact granulomas (LCG).

METHODS

A retrospective analysis was conducted on a cohort of 45 patients diagnosed with LCG at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to May 2023. Based on the treatment modalities administered, patients were categorized into three groups: acid suppression alone, hormone injection combined with acid suppression, and surgery combined with acid suppression. Subsequently, the study compared differences in treatment efficacy and average healing time among these three groups, using various indicators.

RESULTS

The findings indicate that the granuloma size in LCG patients with hoarseness (0.126, 95% CI 0.087-0.288) was significantly greater compared to LCG patients without hoarseness (0.047, 95% CI 0.014-0.083) (P = 0.001). However, there were no significant variations in age, morphology (unlobulated/lobulated), laterality ratio (left/right), sex ratio (male/female), history of tracheal intubation (non-intubation/intubation), and RFS score (RFS > 7/RFS ≤ 7) (P > 0.05), regardless of the presence of hoarseness symptoms. At the treatment observation endpoint of 3 months, the curative ratio in the group receiving hormone injection combined with acid suppression was found to be significantly higher compared to the group receiving acid suppression alone (P = 0.018). In addition, the average healing time of patients in the hormone injection combined with acid suppression group was notably shorter than that of the acid suppression alone group (P = 0.007).

CONCLUSIONS

The combination of hormonal injections and acid suppression may enhance the curative ratio and expedite the healing time of LCG.

LEVEL OF EVIDENCE: 4

Vocal Fold Granuloma: Updates and Advancements in Treatment

OBJECTIVE/HYPOTHESIS

Vocal fold granulomas (VFGs) are benign outgrowths from vocal folds with varying etiologies. If untreated, VFGs can result in mass effects on the surrounding larynx, leading to dysphagia, hoarseness of voice, and possibly dyspnea. With new advancements, novel treatment options and innovative collaborations of previous treatment modalities have started to surface.

STUDY DESIGN

This review aims to provide a world review of the current risks, etiologies, and complications surrounding VFGs, as well as discuss the current and future treatment modalities surrounding VFGs.

METHODS

Four databases (PubMed, Cochrane Library, Embase, and WoS) were searched from the earliest records until February 2023 using search terms related to VFGs. Relevant articles were assessed and analyzed to provide a broad scope of the current treatment options for VFGs.

RESULTS/CONCLUSIONS

The treatment options for VFGs run both wide and deep, ranging from conservative voice therapy to laser vaporization to surgical excision. Within each modality, variations to each technique and method of administration also play a role in maximizing the effectiveness of treatment. Overall, with more higher-powered studies, the complex interplay of treatment modalities can be further untangled to determine the ideal combination treatment for various VFGs.