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Kumar A, Rautji R, Mridha AR, Behera C. Fatal asphyxia due to large laryngeal granuloma. Autops Case Rep 2024; 14:e2024496. [PMID: 39021467 PMCID: PMC11253911 DOI: 10.4322/acr.2024.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
Laryngeal granuloma, vocal process granuloma, or post-intubation granuloma are benign, inflammatory lesions of the arytenoid cartilage vocal process. The etiology of laryngeal granulomas is multifactorial, such as chronic irritation due to endotracheal intubation, vocal cord injury or trauma, and gastroesophageal reflux disease. They can arise postoperatively after mucosal injury due to orotracheal intubation. Clinical manifestations include voice change and dyspnea, which may start one to four months after extubation and may rarely lead to asphyxia. We presented a case of death due to glottic granuloma occurring after a surgical procedure to remove a laryngeal polyp attributed to previous laryngeal injuries by multiple intubations.
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Affiliation(s)
- Ajay Kumar
- All India Institute of Medical Sciences, Department of Forensic Medicine & Toxicology, New Delhi, Delhi, India
| | - Ravi Rautji
- Bharati Vidyapeeth Medical College, Department of Forensic Medicine & Toxicology, Pune, India
| | - Asit Ranjan Mridha
- All India Institute of Medical Sciences, Department of Pathology, New Delhi, Delhi, India
| | - Chittaranjan Behera
- All India Institute of Medical Sciences, Department of Forensic Medicine & Toxicology, New Delhi, Delhi, India
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Clark CM, Abdel-Aty Y, Rives H, Sulica L. De Novo Granuloma of the Membranous Vocal Fold: A Marker of Occult Malignancy. Otolaryngol Head Neck Surg 2024; 170:468-473. [PMID: 37925620 DOI: 10.1002/ohn.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/28/2023] [Accepted: 09/15/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE De novo occurrence of granuloma (granulation tissue) on the membranous vocal fold is not readily explained by usual causes of granuloma at the vocal process. We describe a series of patients. STUDY DESIGN Case series. SETTING Single academic institution. METHODS Cases were identified over a 16-year period. All patients exhibited granulation tissue on pathology. Demographic details, presentation, treatment, histology, and clinical outcomes were recorded. RESULTS Five patients (mean age: 74.0 ± 6.1 years, 40.0% male, 40.0% former smokers) underwent a biopsy. Persistent or recurrent granulation led to a second biopsy in 4 patients an average of 1423.5 days later, revealing a new diagnosis of squamous cell carcinoma (SCC) in situ in one and mild dysplasia in another. Further persistence or recurrence led to a third biopsy or excision an average of 302.3 days later in 3 patients, demonstrating SCC in situ in 1. An average of 2.5 biopsies were required with a mean time to SCC in situ diagnosis of 919.5 days from presentation. Two patients continued to demonstrate persistent granulation tissue on histology. CONCLUSION The membranous vocal fold is an atypical location for granuloma and portends a risk of occult malignancy. The occurrence of de novo granuloma at this site should prompt close long-term clinical surveillance with a low threshold for biopsy. Consideration should be given to tissue collection in the operating room to adequately sample the lesion's base. Concern should persist even after a negative biopsy, and serial observation with repeat biopsy as needed should be pursued.
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Affiliation(s)
- Christine M Clark
- Department of Otolaryngology-Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Yassmeen Abdel-Aty
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Hal Rives
- Department of Otolaryngology-Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York City, New York, USA
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Teng TZJ, Zhai C, Ng CHL. Vocal Fold Granuloma: Updates and Advancements in Treatment. J Voice 2023:S0892-1997(23)00314-4. [PMID: 37985285 DOI: 10.1016/j.jvoice.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/22/2023]
Abstract
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.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Ministry of Health Holdings, Singapore, Singapore; Department of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital, SingHealth, Singapore, Singapore.
| | - Chenlu Zhai
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Christina Hui Lee Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital, SingHealth, Singapore, Singapore
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Lou Z, Lou Z, Lv T, Chen Z. A comparison of radiofrequency Coblation and cold steel excision in the treatment of idiopathic vocal process granulomas. J Laryngol Otol 2023; 137:1003-1009. [PMID: 37403597 DOI: 10.1017/s0022215122001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the effectiveness of radiofrequency Coblation assisted excision and cold steel excision in the treatment of idiopathic vocal process granulomas. METHODS A retrospective study was performed of patients with idiopathic vocal process granulomas who underwent radiofrequency Coblation excision or cold steel excision between January 2013 and January 2020. The recurrence rate was compared among the two groups at six months post-operatively. RESULTS Of the 47 patients with vocal process granulomas, 28 were in the cold steel excision (control) group and 19 were in the Coblation-assisted group. The recurrence rate in the control group was significantly higher than that in the Coblation-assisted group (60.7 per cent vs 5.3 per cent; p < 0.001). In addition, the voice recovery of the Coblation-assisted group was significantly better than that of the control group; vocal quality recovered one month after surgery in the Coblation-assisted group. CONCLUSION Radiofrequency Coblation should be considered the optimal method when approaching idiopathic vocal process granulomas surgically.
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Affiliation(s)
- Z Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, China
| | - Z Lou
- Department of Otolaryngology - Head and Neck Surgery, Shanghai Jiao Tong University affiliated with Sixth People's Hospital, Shanghai City, China
- Center of Sleep Medicine, Shanghai Jiao Tong University affiliated with Sixth People's Hospital, Shanghai City, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai City, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai City, China
| | - T Lv
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, China
| | - Z Chen
- Department of Otolaryngology - Head and Neck Surgery, Shanghai Jiao Tong University affiliated with Sixth People's Hospital, Shanghai City, China
- Center of Sleep Medicine, Shanghai Jiao Tong University affiliated with Sixth People's Hospital, Shanghai City, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai City, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai City, China
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Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of anti-reflux therapy on the idiopathic vocal process granulomas. METHOD This was a prospective case series study. The patients with vocal process granulomas who met the inclusion criteria were analysed. Proton pump inhibitors and vocal hygiene education were conducted for 8-20 weeks. RESULTS Of the 16 patients with vocal process granulomas, 5 (31.25 per cent) patients achieved complete remission. The complete remission rate of granulomas was not significantly related to age (p = 1.000), sex (p = 0.296), side (p = 0.299), position (p = 0.100), endoscopic morphology (p = 0.263) or proton pump inhibitor treatment course (p = 0.543) but was significantly associated with granuloma location (p = 0.001) and granuloma size (p = 0.012). CONCLUSION Granulomas in the vocal cord and the margin of the vocal process had an excellent response to proton pump inhibitors, but granulomas on the surface of vocal process and arytenoid cartilage body had little response to proton pump inhibitors. The prolonged period of proton pump inhibitor treatment did not increase the complete remission rate of vocal process granulomas.
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Abstract
OBJECTIVE This retrospective study was undertaken to assess the outcome of the medical and/or surgical management of patients presenting with clinical features of arytenoid granuloma. METHODS The records of 53 males and 9 females were reviewed for predisposing factors, types of treatment received and recurrence following the treatment. RESULTS Most of the patients (48 out of 62, 77.4 per cent) were treated conservatively with medical management and voice therapy, which resulted in complete resolution of arytenoid granuloma in over two-thirds of the patients treated (32 out of 48, 66.6 per cent). Overall, 28 patients (out of 62, 45.1 per cent) required surgery (14 failed medical treatment cases and 14 surgery as first-line treatment cases). Of these, five patients (out of 28, 17.9 per cent) had recurrence, and were managed with revision surgery and concurrent local injection of Botox. CONCLUSION Anti-reflux medication and voice therapy are effective first-line management options. Pre- and post-surgery adjuvant treatment improves the results of surgery. Local injection of Botox was successful in the treatment of failed surgical cases.
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Pan Y, Li J, Wang X, Zhang J, Zhang C, Liu Z. Prognosis of patients with laryngeal contact granuloma: Development and validation of RCGSG score. Laryngoscope Investig Otolaryngol 2022; 7:1973-1978. [PMID: 36544923 PMCID: PMC9764766 DOI: 10.1002/lio2.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Objective This study aimed to develop an objective and simple score for predicting the prognosis of patients with laryngeal contact granuloma (LCG) treated with local glucocorticoid injection combined with oral proton pump inhibitor (GI + PPI). Methods Cox regression analysis was used to analyze the effect of baseline variables on the prognosis of 507 patients with LCG treated with GI + PPI. An easy-to-apply RCGSG (Reflus, Cough, Gender, and Surgery in GI + PPI therapy) score was developed based on the independent risk factors selected by univariate and multivariate Cox regression analyses. The score was internally validated by receiver-operating characteristic curve, calibration curve, and decision curve analysis. Results After univariate and multivariate analyses, male gender (hazard ratio [HR] 0.546, p < .001), laryngopharyngeal reflux (HR 0.702, p = .001), chronic cough (HR 0.709, p = .001), and history of surgical resection (HR 0.433, p < .001) were found to be the independent risk factors affecting the prognosis of LCG. According to the score, the median cure time was 3 months (95% confidence interval [CI] 2.81-3.19) in the low-risk group, 4 months (95% CI 3.74-4.26) in the moderate-risk group, and 5 months (95% CI 4.76-5.24) in the high-risk group. The bootstrap method was used to plot calibration curves for internal validation. Conclusion The RCGSG score, developed based on laryngopharyngeal reflux, chronic cough, gender, and surgical resection history, has been internally verified to be a good predictor of the prognosis of patients with LCG receiving GI + PPI treatment. Level of evidence Level 4.
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Affiliation(s)
- Yufei Pan
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Jinrang Li
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Xiaoyu Wang
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Jinhong Zhang
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Chun Zhang
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Zhi Liu
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
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Ding L, Lv T, Lou Z. The recurrent factors of idiopathic vocal process granulomas after cold steel excision. Am J Otolaryngol 2022; 43:103454. [PMID: 35413544 DOI: 10.1016/j.amjoto.2022.103454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/22/2022] [Accepted: 04/04/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To identify the factors predicting postoperative recurrence after cold steel excision for the market trader with idiopathic vocal process granulomas (VPGs). MATERIAL AND METHODS The market traders with idiopathic VPGs who do not respond to medical treatment were treated by cold steel excision. The factors considered likely to affect the recurrence were evaluated by univariate and multivariate logistic regression. RESULTS The total of 80 idiopathic VPGs underwent the cold steel excision. All postoperative 6 months, the complete remission rate was 37.5% (30 VPGs) and 50 recurrences developed (62.5%). The recurrence rate was not significantly associated with sex (P = 0.119), side (P = 0.468), VPG size (P = 0.726), LPR (P = 0.293), diabetes mellitus (P = 0.5611), cerebrovascular disease (P = 0.129), or chronic pulmonary disease (P = 0.190). Multivariate logistic regression showed that only vocalization frequency (P = 0.006) and smoking and alcohol consumption (P = 0.001) were independent predictors of recurrence. There was no significant correlation between age and recurrence (P = 0.59). However, recurrence was more common in those aged 51-60 years than those aged ≥61 years (P = 0.019). Of the recurrent 49 VPGs treated conservatively via behavioural modification and oral deanxit, the granulomas disappeared spontaneously in 38 (77.6%) within 6-10 months and in 11 (22.4%) within 2-3 years. CONCLUSIONS The market traders with VPG would be a high recurrence rate after cold steel excision, the frequency of voice use and smoking and alcohol consumption were significant independent predictors of recurrence. Antidepressant medications and behavioural modification could effectively improve the outcome of VPG.
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Ding J, Jiang Z, Lou Z. Radiofrequency ablation of intubation granulomas. Am J Otolaryngol 2022; 43:103326. [PMID: 34952418 DOI: 10.1016/j.amjoto.2021.103326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE We explored the outcomes and voice parameters of patients undergoing plasma radiofrequency (RF) ablation to treat intubation granulomas. STUDY DESIGN Prospective case series. METHODS AND MATERIALS Patients with intubation granulomas who met the inclusion criteria underwent RF ablation. The complete remission rate and voice function were evaluated preoperatively and at 6 months postoperatively. RESULTS We enrolled 13 patients with 25 intubation granulomas. The mean time between intubation and initial diagnosis was 38.6 days and that between intubation and surgical diagnosis was 2.7 months. All 25 granulomas were successfully removed and histologically confirmed. No surgical remnant was evident on the vocal folds and complete glottal closure was observed at 2 weeks postoperatively. No recurrence or RF ablation-related complications were observed during the 6-month follow-up. The complete remission rate was 100% (13/13). In addition, the mean hoarseness, roughness, breathiness, asthenia, and strain (GRBAS) scores, and the maximum phonation time (MPT), improved significantly after treatment (all P < 0.05). CONCLUSIONS RF ablation is effective and safe for patients with intubation granulomas who failed medical management or request the procedure. In this study, the complete resolution rate was high and voice restoration outcomes were good.
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Nie Q, Li J, Zou S, Zhang R. Factors for Predicting the Therapeutic Efficacy of Laryngeal Contact Granuloma. J Voice 2020; 36:737.e17-737.e23. [PMID: 32917458 DOI: 10.1016/j.jvoice.2020.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the factors affecting the therapeutic efficacy of laryngeal contact granuloma. METHODS The clinical data of 534 patients with laryngeal contact granuloma treated in our hospital from April 2014 to December 2019 were studied. The multivariable logistic regression was performed to find the risk factors influencing the treatment efficacy. RESULTS Multivariable logistic regression showed that factors related to therapeutic efficacy were granuloma size (P = 0.0006) and gender (P = 0.0299) in conservative treatment group; laryngopharyngeal reflux (P = 0.0115), cough (P = 0.0124), and previous surgical history (P < 0.001) in combined treatment group. The surgical treatment had the worst therapeutic efficacy compared with combined treatment and conservative treatment. In the larger granuloma size subgroup, combined treatment showed better results than conservative treatment. CONCLUSION Granuloma size and gender affect the therapeutic efficacy of conservative treatment. Previous surgical history, laryngopharyngeal reflux, and cough affect the therapeutic efficacy of combined treatment. Combined treatment is better than conservative treatment alone and surgical treatment shows the worst efficacy.
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Affiliation(s)
- Qian Nie
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Jinrang Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.
| | - Shizhen Zou
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Ran Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
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Ho CF, Lee YC, Hsin LJ, Lee LA, Li HY, Fang TJ. Low-Dose LEMG-Guided Botulinum Toxin Type A Injection for Intractable Vocal Process Granulomas. J Voice 2020; 36:277-282. [PMID: 32595029 DOI: 10.1016/j.jvoice.2020.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Vocal process granuloma (VPG) has a varied treatment success rate and may frustrate patients and physicians due to poor outcomes. There is still a lack of standard protocols to manage VPG. This study aimed to review the efficiency of a standardized low-dose laryngeal electromyographic (LEMG)-guided botulinum toxin A (BTA) injection in intractable vocal granulomas. METHODS Twenty-four patients with intractable VPG were recruited. All patients underwent percutaneous LEMG-guided BTA injection on the thyroarytenoid-lateral cricoarytenoid muscle complex in an office setting. The injecting dose was standardized to 1 U in 0.1 mL normal saline at a time. We evaluated the treatment effect by measuring the lesion size with serial laryngoscope evaluations. RESULTS The postinjection follow-up time varied from 3 to 23 months. Twenty-one patients (87.5%) experienced complete regression of the granuloma over 1-7 months (median 3 months). No major adverse effects were noted during the follow-up period. CONCLUSION For recalcitrant VPG, LEMG-guided low-dose BTA injection has the potential to be a safe, efficient, and effective treatment.
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Affiliation(s)
- Che-Fang Ho
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Li-Jen Hsin
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Ang Lee
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Heyduck A, Pickhard A, Olthoff A, Hoffmann T, Reiter R. [Therapeutic success of proton pump inhibitors in the therapy of contact granulomas]. Laryngorhinootologie 2020; 100:202-206. [PMID: 32557506 DOI: 10.1055/a-1190-4907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
According to the current S2k guideline "Gastroesophageal Reflux Disease (GERD)" of 05/2014, an empirical proton pump inhibitor (PPI) therapy in double standard dose (e. g. Pantoprazole 40 mg 2 ×/day) is recommended for the extraesophageal GERD manifestation (e. g. with formation of a contact granuloma, CG) for 8 weeks. However, valid study data don't exist.In a prospective study from 05.2015 to 12.2019 39 patients consecutively randomized with endoscopically proven KG received PPIs in single (1 × PPI, n = 22) or double standard dose (2 × PPI, n = 17) for 8 weeks. A possible gastrolaryngeal reflux as well as throat sensations, a tendency to clear the throat or a hoarseness were recorded at first presentation and at control after 4 months.This was archieved by videolaryngostroboscopy to detect hoarseness and to assess the development of the granuloma (progression, constant, remission < 50 %, > 50 % or complete). The two groups were compared.The granuloma disappeared or regressed in 40 % of the cases with 1 × PPIs and in 77 % of the cases with 2 × PPIs (p < 0.05) after therapy. At the control appointment 23 % of the patients with 1 × PPIs were completely symptom-free and 77 % of the patients with 2 × PPIs. Throat sensation was the most frequent symptom at first presentation with 64 %. In the control group after PPI therapy in single or double standard dose, throat sensations were only detectable in 33 % and 15 % in case of granuloma remission. However, if the granuloma was persistent, the symptoms could hardly be influenced.The therapy of a KG with PPIs in double standard dose is more effective than in single standard dose. These results must be confirmed on a larger collective.
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Affiliation(s)
- Adrienne Heyduck
- Sektion Phoniatrie und Pädaudiologie der Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Univ.-Klinik Ulm, Ulm, Germany.,Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Göttingen, Phoniatrie und Pädaudiologie, Göttingen, Germany
| | - Anja Pickhard
- Hals-Nasen-Ohrenklinik, Technische Universität München, Germany
| | - Arno Olthoff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Göttingen, Phoniatrie und Pädaudiologie, Göttingen, Germany
| | - Thomas Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Univ.-Klinik Ulm, Ulm, Germany
| | - Rudolf Reiter
- Sektion Phoniatrie und Pädaudiologie der Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Univ.-Klinik Ulm, Ulm, Germany
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Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma. The Journal of Laryngology & Otology 2019; 133:1041-1045. [PMID: 31711548 DOI: 10.1017/s0022215119002159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To report on the efficacy and adverse effects of interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma. METHODS A retrospective chart review was conducted of eight patients with vocal process granuloma resistant to anti-reflux therapy who underwent interarytenoid botulinum toxin A injection. The mean dosage of botulinum toxin A injected was 6.56 U. RESULTS Fifty per cent of patients had complete regression of the lesion and 50 per cent had partial regression. The main side effects were breathiness (n = 4), voice breaks (n = 1) and aspiration (n = 1). CONCLUSION Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma is an effective mode of therapy, with transient vocal and swallowing side effects.
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Tsai SW, Ma YF, Shih LC, Tsou YA, Sung CK. Operative and Conservative Management of Laryngeal Contact Granuloma: A Network Analysis and Systematic Review. J Voice 2019; 35:300-306. [PMID: 31628044 DOI: 10.1016/j.jvoice.2019.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Laryngeal contact granuloma is a disease of benign hypertrophic granulation tissue at the medial side of vocal process. Numerous studies of conservative and surgical management have reported effectiveness, yet optimal treatment has not been standardized. We compared primary and secondary outcomes of conservative and surgical treatment using endoscopic grading, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT), and recurrence rate. METHODS We performed literature searches of MEDLINE, PubMed, and EMBASE from November 1985 to October 2017, with randomized controlled trials and case control studies of at least three months follow-up as the inclusion criteria. Outcomes included laryngoscopic findings, MPT, and VHI-10. Data regarding study design, outcome analysis, follow-up time, and disease remission were systematically collected. RESULTS A total of 1069 patients were abstracted from 19 papers. With conservative treatment, 98% of patients' laryngeal granuloma resolved within three months, and 84% for the surgical group. There was a decrease in VHI-10 of 2.69 (95% credible interval (CI) -9.52 to 3.82) and 6.48 (95% CI -15.00 to 1.94) for conservative and surgical management, respectively. MPT improvement was 1.27 s (95% CI: 2.03-5.84) for conservative treatment and 5.02 s (95% CI: 0.78-8.07) for surgical. For all 19 studies, absolute recurrence risk for control, conservative, and surgical measures were respectively 4%, 16%, and 29%. CONCLUSIONS Most patients treated conservatively or surgically alone responded to treatment, but conservative management was favored. VHI-10 and MPT improvement in surgical patients were noted, but only the latter was statistically significant. In regard to recurrence, conservative management had better outcome than surgical. Taken together, the results suggest that minimally symptomatic granulomas have higher response rate and lower recurrence risk when treated conservatively, while larger, symptomatic granulomas may favor surgical excision followed by medical management to reduce risk of recurrence.
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Affiliation(s)
- Shu Wei Tsai
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California; National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Department of Otolaryngology, Tainan, Taiwan, ROC
| | - Yi Fei Ma
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Liang Chun Shih
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California; China Medical University Hospital, College of Medicine, Department of Otolaryngology, Taichung, Taiwan, ROC
| | - Yung An Tsou
- China Medical University Hospital, College of Medicine, Department of Otolaryngology, Taichung, Taiwan, ROC
| | - Chih-Kwang Sung
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
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The treatment of vocal process granuloma. Am J Otolaryngol 2018; 39:367-368. [PMID: 29398186 DOI: 10.1016/j.amjoto.2018.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/28/2018] [Indexed: 11/22/2022]
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Surgical Treatment Outcomes of Vocal Process Granuloma After Endotracheal Intubation. J Craniofac Surg 2018; 29:e387-e389. [PMID: 29481512 DOI: 10.1097/scs.0000000000004389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The objective of this study was to review the clinical characteristics and surgical treatment outcomes of the vocal process granuloma after the endotracheal intubation. METHODS A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2008 to December 2015. RESULTS Twenty-one vocal process granulomas after endotracheal intubation were diagnosed in 13 patients. The most common symptom was hoarseness. Among 13 patients, bilateral vocal process granulomas were in 8 patients. For the remaining 5 patients, their unilateral vocal process granulomas were all left-sided. All the cases of vocal process granulomas after the endotracheal intubation were treated by laryngoscope microsurgery under general anesthesia. Recurrence of vocal process granulomas was identified in 1 lesion. CONCLUSION This study suggests that surgery for vocal process granuloma after endotracheal intubation is a good treatment option for a rapid resolution of lesions and the associated symptoms, along with having low recurrence rates.
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Pham Q, Campbell R, Mattioni J, Sataloff R. Botulinum Toxin Injections Into the Lateral Cricoarytenoid Muscles for Vocal Process Granuloma. J Voice 2017; 32:363-366. [PMID: 28778373 DOI: 10.1016/j.jvoice.2017.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Contact granulomas are benign, exophytic inflammatory lesions of the larynx that typically arise on or near the vocal process of the arytenoid cartilage. The most common management options include voice therapy and antireflux pharmacotherapy, intralesional steroid injections, botulinum toxin injections, and surgical excision. In-office Botox injection into the lateral cricoarytenoid (LCA) muscle can be effective even for recurrent granulomas. STUDY DESIGN This is a retrospective chart review and literature review. METHOD We reviewed more than 400 charts and included two patients, who underwent in-office injection with botulinum toxin A into LCA muscles bilaterally, after previously failing both conservative and surgical management. RESULTS Both cases showed significant improvement of the laryngeal granulomas after 6 months and a single botulinum toxin injection. Both cases were initially grade III granuloma that improved to grade I. CONCLUSIONS In-office injection of botulinum toxin A targeting the LCA muscle appears to be a safe and effective treatment modality in refractory laryngeal granuloma.
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Affiliation(s)
- Q Pham
- Philadelphia College of Osteopathic Medicine, Department of Otolaryngology-Head & Neck Surgery, Rowland Hall-Graduate Medical Education, Philadelphia, Pennsylvania.
| | - R Campbell
- University of Ottawa, Department of Otolaryngology-Head & Neck Surgery, Ottawa, Ontario, Canada
| | - J Mattioni
- Philadelphia College of Osteopathic Medicine, Department of Otolaryngology-Head & Neck Surgery, Rowland Hall-Graduate Medical Education, Philadelphia, Pennsylvania
| | - R Sataloff
- Drexel University College Of Medicine, Department of Otolaryngology-Head & Neck Surgery, Philadelphia, Pennsylvania
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Botulinum Toxin A for Treatment of Contact Granuloma. J Voice 2016; 30:741-743. [DOI: 10.1016/j.jvoice.2015.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022]
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Hu HC, Hung YT, Lin SY, Chang SY. Office-based Autologous Fat Injection Laryngoplasty for Vocal Process Granuloma. J Voice 2015; 30:758.e7-758.e11. [PMID: 26454769 DOI: 10.1016/j.jvoice.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present the outcomes of office-based autologous fat injection laryngoplasty for the treatment of vocal process granuloma in conjunction with glottic insufficiency. STUDY DESIGN Retrospective chart review. METHODS This study included nine patients with vocal process granuloma in conjunction with glottic insufficiency who received autologous fat injection laryngoplasty. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were examined before and after treatment. RESULTS Of the nine patients, seven (78%) exhibited complete remission. The other two patients (22%) exhibited a partial response following the injection. In a subgroup of five patients who were refractory to antireflux and voice therapies, the resolution rate was 60%. Phonatory function presented significant improvements in jitter, noise-to-harmonic ratio, maximal phonation time, and asthenia. Videolaryngostroboscopic rating revealed significant improvements in closure phase ratio in the vibratory cycle. CONCLUSIONS Autologous fat injection laryngoplasty can ameliorate glottic insufficiency and the resulting hyperfunctional behavior of the larynx. This therapy also encourages remission of vocal process granuloma and may represent an alternative treatment strategy.
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Affiliation(s)
- Hao-Chun Hu
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yi-Ting Hung
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shu-Yi Lin
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shyue-Yih Chang
- Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan..
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Laryngeal Granuloma - Benefit in Treatment with Zinc Supplementation? J Med Biochem 2015; 34:228-232. [PMID: 28356836 PMCID: PMC4922326 DOI: 10.2478/jomb-2014-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/26/2013] [Indexed: 11/25/2022] Open
Abstract
Laryngeal granulomas present as contact and postintubation ulcers and granulomas. Essentially, a contact granuloma is a pseudotumor of the lateral wall of the posterior glottis. The most common etiological factor is voice abuse, with predisponing factors such as reflux disease. Postintubation ulcers and granulomas, although of different etiology, according to all the other traits belong to this clinical entity. The therapy of choice is conservative treatment. Surgical laser excision is indicated for resistant cases and those whose size is causing respiratory distress. Treatment of laryngeal granulomas with zinc supplementation is reported in the literature as one of the forms of conservative treatment, and we wanted to consider it in this review. Zinc is an essential mineral that plays a vital role in many biochemical reactions and is considered very important for wound healing.
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Ma L, Xiao Y, Ye J, Yang Q, Wang J. Analysis of therapeutic methods for treating vocal process granulomas. Acta Otolaryngol 2015; 135:277-82. [PMID: 25627796 DOI: 10.3109/00016489.2014.986756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The combination of laryngeal microsurgery and local injections of botulinum toxin type A (BTA) can increase the cure rate of patients with vocal process granulomas (VPGs). OBJECTIVE To analyze the therapeutic effects of conservative treatments, microsurgical resection with suturing and microsurgery in combination with local injections of BTA for the treatment of VPGs. METHODS A retrospective analysis of 168 cases of VPG was performed. All of the patients initially received a conservative treatment. Some of the patients who did not respond to the conservative treatments were treated using microsurgical resection and microsuturing using an 8-0 absorbable filament. Other patients additionally received a four-point injection of BTA into the thyroarytenoid muscle and the arytenoid muscle on the operated side. RESULTS The lesions of 41.3% (71/168) of the patients who were given the conservative treatments (including acid suppression, vocal rest, and voice therapy) disappeared, and the lesions of 10.7% (18/168) of the patients were reduced. The conservative treatments were unsuccessful for 47% (79/168) of the patients. The cure rate was 78.4% (29/37) for the patients who were treated by microscope resection using a CO2 laser and microsuturing of the surrounding mucosa. Of the eight patients who experienced a recurrence, five of them had lesions that disappeared after 3 months of conservative treatment, whereas the other three patients recovered after a second operation. The cure rate of the 42 patients who were treated using microsurgery combined with local injections of BTA was 95.2% (40/42), with only 2 cases of recurrence at 2 months post-treatment.
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Affiliation(s)
- Lijing Ma
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University , Beijing , China
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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; 270:2921-6. [DOI: 10.1007/s00405-013-2527-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/22/2013] [Indexed: 11/30/2022]
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Sun GB, Sun N, Tang HH, Zhu QB, Wen W, Zheng HL. Zinc sulfate therapy of vocal process granuloma. Eur Arch Otorhinolaryngol 2012; 269:2087-90. [DOI: 10.1007/s00405-012-1971-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
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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; 45:821-5. [DOI: 10.1016/j.oraloncology.2009.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 01/09/2009] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
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Belafsky PC, Rees CJ. Laryngopharyngeal reflux: the value of otolaryngology examination. Curr Gastroenterol Rep 2008; 10:278-282. [PMID: 18625139 DOI: 10.1007/s11894-008-0056-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Laryngopharyngeal reflux (LPR) is the disease process by which gastric contents affect the extraesophageal structures of the head and neck. The symptoms of LPR include intermittent dysphonia, excessive throat clearing, globus pharyngeus, cough, and dysphagia. These symptoms can be assessed with the Reflux Symptom Index. Signs of LPR, as determined with laryngoscopy, can be described with the Reflux Findings Score, which includes assessment of site-specific laryngeal edema and other inflammatory changes. This article discusses the current understanding of LPR pathophysiology, taking into account pepsin stability and reactivation.
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Affiliation(s)
- Peter C Belafsky
- Center for Voice and Swallowing, Department of Otolaryngology Head and Neck Surgery, University of California, Davis School of Medicine, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA.
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