1
|
Yu PJ, Hung WC, Wang CT. Treatment Outcomes of Intralesional Steroid Injection for Refractory Vocal Process Granuloma. Clin Otolaryngol 2024; 49:822-826. [PMID: 39135379 DOI: 10.1111/coa.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 12/25/2023] [Accepted: 07/26/2024] [Indexed: 10/05/2024]
Abstract
OBJECTIVES Vocal process granuloma (VPG) is a chronic condition resulting from a mucoperichondrial injury of vocal process. Initial conservative treatment typically involves vocal hygiene education and antireflux medication. Treatment challenges arise with refractory cases. Outcomes of second-line treatments such as surgical excision and botulinum toxin injections remain inconsistent. Thus, we propose this study to investigate the effectiveness of intralesional steroid injections for refractory VPG. METHODS We conducted a retrospective review of 23 patients with VPG who showed no improvement after 3 months of proton pump inhibitors. These patients underwent one to three courses of monthly in-office intralesional steroid injections as a second-line therapy. Treatment outcomes were evaluated by measuring the size of the VPG relative to the length of the vocal folds before and after the final injection procedure. RESULTS Results showed a significant reduction in VPG size from baseline of 27.74 ± 15.06 to 5.48 ± 8.95 (p < .001). 15 out of 23 patients were responsive (size reduction ≥ 75%) to intralesional steroid injection. Alcohol consumption and longer symptom duration were associated with a poor response (size reduction <75%), whereas prior intubation was associated with better response. CONCLUSIONS For refractory VPG not responding to conservative treatment, intralesional steroid injection appears to be a promising alternative option without significant adverse effects.
Collapse
Affiliation(s)
- Po-Jun Yu
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Chen Hung
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Boyce C, Schmidt KL, Gilbert MR. Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists. Laryngoscope 2024; 134:795-802. [PMID: 37602761 DOI: 10.1002/lary.30976] [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] [Received: 05/18/2023] [Revised: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Vocal process granulomas (VPGs) are benign laryngeal lesions that may manifest as ulcerated regions of the vocal fold or nodular polypoid lesions. Gold standard treatments for idiopathic VPG are yet to be established at this time. This study evaluated clinical decision-making and outcomes in the treatment of VPG patients based on experiences of academic laryngologists across the United States. METHODS A 21-question survey was developed to evaluate each respondent's specific VPG patient population, clinical decision-making in treating VPG, and corresponding treatment outcomes. The survey was distributed to 168 laryngologists at academic institutions across the United States. Data were analyzed through the Qualtrics platform. RESULTS A total of 106 responses were analyzed, with a completion rate of 63.1%. Etiology of VPG was most commonly attributed to phonotrauma (96.2%) and reflux (71.8%). Primary first-line treatment was most commonly antireflux medications (92%). Other common first line treatments included voice therapy (58.8%) and inhaled steroids (42.5%). With these treatments, the majority of laryngologists report that recurrence is uncommon (68.4%). Dysphonia was cited as the most frequent long-term sequelae at 27.8%. CONCLUSIONS VPG treatment strategies continue to be controversial across the United States with many treatments described in the literature with variable application in the practice of academic laryngologists today. Based on survey results, antireflux medications and voice therapy may be the most widely used and most effective treatment options. Establishment of gold standard therapy for VPG as well as further research into recurrent or persistent VPG despite antireflux and voice therapy should be explored. LEVEL OF EVIDENCE 5 Laryngoscope, 134:795-802, 2024.
Collapse
Affiliation(s)
- Claire Boyce
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kelly L Schmidt
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Mark R Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|
4
|
Ban MJ, Ryu CH, Woo JH, Lee YC, Lee DK, Kwon M, Hong YT, Lee GJ, Byeon HK, Choi SH, Lee SW. Guidelines for the Use of Botulinum Toxin in Otolaryngology From the Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force. Clin Exp Otorhinolaryngol 2023; 16:291-307. [PMID: 37905325 DOI: 10.21053/ceo.2023.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey's syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.
Collapse
Affiliation(s)
- Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Joo Hyun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dong Kun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Tae Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Gil Joon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| |
Collapse
|
5
|
Alarfaj AA. Unraveling the Power of Topical Inhaled Steroids in Treating Laryngeal Granulomas: A Systematic Review. Life (Basel) 2023; 13:1984. [PMID: 37895366 PMCID: PMC10608710 DOI: 10.3390/life13101984] [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: 08/25/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
The efficacy of inhaled steroids in the treatment of airway laryngeal granuloma is an important topic of research, given the increasing prevalence of this condition. In this systematic review, we aimed to evaluate the existing evidence on the effectiveness of inhaled steroids in treating airway granuloma. The search was performed in several electronic databases including PubMed, Embase, and the Cochrane Library. We included all relevant studies that were published in the English language between 2005 and 2021. A total of nine studies were eligible for inclusion in our systematic review, including one randomized controlled trial, one case-control study, and seven retrospective studies. The results of our review suggest that inhaled steroids may be effective in treating airway granuloma, but more research is needed to confirm these findings. The limitations of the included studies, such as small sample sizes, inconsistent study designs, and a lack of long-term follow-up, suggest that additional research is needed to confirm the effectiveness of inhaled steroids in treating airway granuloma. Overall, this systematic review highlights the need for further studies to confirm the effectiveness of inhaled steroids in treating airway granuloma.
Collapse
Affiliation(s)
- Abdullah A Alarfaj
- Otolaryngology Unit, Department of Surgery, King Faisal University, Al Ahsa 31982, Saudi Arabia
| |
Collapse
|
6
|
Woo JH, Oh JH, Lim BW, Kim DY. Treatment Results of Vocal Process Granuloma: Intubation versus Contact Granuloma. Int Arch Otorhinolaryngol 2023; 27:e191-e196. [PMID: 37125377 PMCID: PMC10147457 DOI: 10.1055/s-0043-1768205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/07/2021] [Indexed: 05/02/2023] Open
Abstract
Introduction Contact granulomas (CGs) and intubation granulomas (IGs) are known to have different clinical manifestations despite having the same pathological features. Objective The purpose of the present study was to analyze the treatment results for CG and IG and to obtain clinical information. Methods We retrospectively reviewed the medical records of patients diagnosed with vocal process granuloma (VPG) between January 2015 and December 2018. The patient's age, sex, medical history, lesion size, lesion type, reflux finding score (RFS), response to treatment, duration of treatment, and follow-up period were compared. Results Eighteen patients with CG and 14 patients with IG were included in the study. The IG group had more female patients ( p = 0.0009), showed better response to proton pump inhibitor (PPI) and steroid inhalation (SI) ( p = 0.036), and had a shorter treatment period ( p = 0.0029) than the CG group. Five patients who received botulinum toxin injections in their vocal cords had complete remission. Conclusion Compared with CG, IG was more responsive to treatment with PPI and SI and required a shorter duration of treatment.
Collapse
Affiliation(s)
- Joo Hyun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
- Address for correspondence Joo Hyun Woo, MD, PhD Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University, Gil Medical Center, ENT officeNamdong-daero 774 beon-gil 21, Namdong-gu, Incheon 21565South Korea
| | - Jae Hwan Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
| | - Byung Woo Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
| | - Dong Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University College of Medicine, Gil Medical Center, Seongnam, South Korea
| |
Collapse
|
7
|
McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [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: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
Collapse
Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
8
|
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.
Collapse
|
9
|
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.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Pan Y, Li J, Zhang J, Wang X, Jia Y. Thyroarytenoid botulinum toxin injection for refractory laryngeal contact granuloma. Am J Otolaryngol 2022; 43:103482. [PMID: 35567839 DOI: 10.1016/j.amjoto.2022.103482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/01/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although there are many treatments for laryngeal contact granuloma (LCG), some patients still fail treatment. Botulinum toxin A injection vocal cords may be a salvage therapy. OBJECTIVES To study the efficacy of thyroarytenoid botulinum toxin A injection for the treatment of refractory LCG. MATERIAL AND METHODS From May 2021 to March 2022, 23 male patients with refractory idiopathic LCG were treated by injection of botulinum toxin A into the thyroarytenoid muscle via the thyrohyoid membrane approach. Inspiratory-phase laryngoscopy images were collected before treatment and 3 months after injection treatment. The lesion size was evaluated with the Farwell granuloma endoscopic grading system and Image J software. RESULTS The average age of 23 patients was 49 years. The dose of botulinum toxin injection ranged from 2.5 to 5 units. Three months after injection, 17 patients were cured, 2 patients showed marked improvement, and 4 patients did not experience any effect. The total efficacy rate was 82.61% (19/23), and no serious complications occurred. Almost all patients experienced hoarseness within one week after injection; they gradually recovered after one month, and their voice returned to baseline at 3 months. CONCLUSIONS Thyroarytenoid botulinum toxin injection is an effective method for resolving refractory LCG.
Collapse
|
12
|
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.
Collapse
|
13
|
Shah VN, Suresh NV, Pasick LJ, Ghiam MK, Torres LA. Pediatric bilateral vocal cord granulomas presenting as airway foreign body following prolonged intubation due to COVID-19 related multisystem inflammatory syndrome. OTOLARYNGOLOGY CASE REPORTS 2021; 20:100311. [PMID: 34957360 PMCID: PMC8076726 DOI: 10.1016/j.xocr.2021.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background This report is a case of bilateral vocal cord granulomas (VCG) in a 9-year-old child presenting as an airway foreign body and stridor following prolonged intubation due to COVID-19 pneumonia complicated by multisystem inflammatory syndrome in children (MIS-C). Case presentation This case reports a 9-year-old male who presented to the emergency department with acute stridor concerning for airway obstruction. X-ray findings suggested an airway foreign body; however, on rigid bronchoscopy, ball-valving bilateral VCG obstructing 90% of the glottic airway were identified. After excision of the VCGs, the patient's symptoms resolved with no postoperative complications. Conclusion With suspected foreign body aspiration in a pediatric patient with a history of prolonged intubation, it is important to consider a broad differential diagnosis. VCGs are rare complications of prolonged intubation that could be in children with prior history of intubation following COVID-19 pneumonia.
Collapse
Affiliation(s)
- Viraj N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neeraj V Suresh
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luke J Pasick
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael K Ghiam
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Leonardo A Torres
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
14
|
Liang TJ, Wang NY, Liu SI, Chen IS. Vocal cord granuloma after transoral thyroidectomy using oral endotracheal intubation: two case reports. BMC Anesthesiol 2021; 21:170. [PMID: 34126924 PMCID: PMC8201730 DOI: 10.1186/s12871-021-01393-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background Transoral thyroidectomy can be performed using nasal or oral intubation. Recently, we encountered two cases of vocal cord granuloma that were suspected to result from intraoperative compression by the oral endotracheal tube. Cases presentation Two women underwent transoral endoscopic thyroidectomy with oral endotracheal tubes fixed at the mouth angle. Their initial postoperative recovery was uneventful, but they developed hoarseness 2 months after the surgery. Subsequent strobolaryngoscopy revealed vocal cord granulomas at the side of contact of the endotracheal tube. One patient received medication and voice therapy, and her granuloma shrank significantly one month later. The other patient underwent granuloma resection. Thereafter, the symptoms improved in both the patients. Conclusions Oral intubation with tube placement at the mouth angle might result in the formation of vocal cord granulomas. Therefore, we suggest positioning the tube at the midline to avoid excessive irritation on one side of the vocal cord.
Collapse
Affiliation(s)
- Tsung-Jung Liang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, 81362, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, 11221, Taipei, Taiwan
| | - Nai-Yu Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, 81362, Kaohsiung, Taiwan
| | - Shiuh-Inn Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, 81362, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, 11221, Taipei, Taiwan
| | - I-Shu Chen
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, 81362, Kaohsiung, Taiwan.
| |
Collapse
|
15
|
Li K, Chen WY, Li YY, Wang TL, Tan MJ, Chen Z, Chen H. Laryngopharyngeal reflux disease management for recurrent laryngeal contact granuloma: A case report. World J Clin Cases 2021; 9:1989-1995. [PMID: 33748251 PMCID: PMC7953387 DOI: 10.12998/wjcc.v9.i8.1989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laryngeal contact granuloma (LCG) is difficult to treat and frequently associated with high persistence and recurrence, despite the availability of both surgical and pharmacological treatment options. An appropriate strategy is therefore needed to help patients with multiple recurrences of LCG to potentially avoid unnecess-ary surgery.
CASE SUMMARY We describe the case of a 34-year-old male patient with recurrent LCG in which a good response was achieved through successful management of laryngophar-yngeal reflux disease using a combination pharmacotherapeutic regimen consisting of anti-reflux therapy, pepsin secretion inhibition, bile acid neutralization, and lifestyle modifications. This patient underwent surgery to excise the granuloma, then relapsed, underwent a second surgery, which was followed by a second recurrence. The granuloma then disappeared after 9 mo of combined treatment with ilaprazole enteric-coated capsules (10 mg qd), mosapride tablets (5 mg tid) and compound digestive enzyme capsules (2 tablets). The drug regimen was discontinued after one year, and no recurrence of the lesion has been reported during the one-year follow-up period.
CONCLUSION We report a combination of pharmacotherapeutics and lifestyle modifications for the management of laryngopharyngeal reflux disease to address recurring LCG.
Collapse
Affiliation(s)
- Kai Li
- Department of Otorhinolaryngology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Wen-Yong Chen
- Department of Otorhinolaryngology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Yun-Ying Li
- Department of Otorhinolaryngology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Tu-Lu Wang
- Department of Otorhinolaryngology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Meng-Jia Tan
- Department of Otorhinolaryngology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Zong Chen
- Department of Otorhinolaryngology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Hai Chen
- Department of Otorhinolaryngology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| |
Collapse
|
16
|
Comparison of PPI and combined treatment in the treatment of recurrent laryngeal contact granuloma. Am J Otolaryngol 2021; 42:102766. [PMID: 33125906 DOI: 10.1016/j.amjoto.2020.102766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the therapeutic effect of PPI and combined treatment in the treatment of patients with recurrent laryngeal contact granuloma. METHODS The clinical data of 299 patients with recurrent laryngeal contact granuloma treated with PPI or combined treatment (PPI with glucocorticoid injection into granuloma by the thyroglossal approach) from February 2013 to June 2019 were analyzed retrospectively. Patients were divided into two subgroups: PPI and combined treatment. The cure rates, recurrence rates and cure time of the two subgroups were compared and analyzed separately. Than we can get the optimal treatment of the two treatment in the treatment of recurrent patients. RESULTS In recurrent patients, the cure rate (81.20%) and recurrence rate (3%) of combined treatment were superior to those of PPI (57.58%) and recurrence rate (12.12%); (P < 0.05). The cure time of PPI was longer than that of combination therapy (P < 0.001). CONCLUSION The therapeutic effect of combined treatment is better than that of PPI in patients with recurrence. At the same time, combined treatment is an effective treatment for recurrent granuloma and can be used as a first-line treatment for recurrent laryngeal contact granuloma.
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW This review explores the recent evidence and established scientific literature surrounding proton pump inhibitors in the context of laryngology. RECENT FINDINGS Proton pump inhibitors are often associated with gastroenterology; however, they also have a place in laryngology. Several laryngopharyngeal disorders are treated with proton pump inhibitors, though limited evidence regarding effectiveness, dosing and length of treatment exists. With the recent influx of articles reporting possible adverse effects of proton pump inhibitors, the appropriate prescribing of them has come under scrutiny. These reported risks include cancer, stroke, myocardial infarction, kidney disease and cognitive decline. It should be noted though that many of these studies by nature, are fraught with potential confounding. Regardless, clinicians ought to be aware of any risks associated with treatment regimens and prescribe the optimal dosage and duration. SUMMARY Proton pump inhibitor treatment should be dose-appropriate and for a limited duration. Concerning potential adverse effects, the limitations of retrospective cohort studies must be taken into consideration when reviewing the evidence.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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.
| |
Collapse
|
20
|
Lechien JR, Akst LM, Saussez S, Crevier-Buchman L, Hans S, Barillari MR, Calvo-Henriquez C, Bock JM, Carroll TL. Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review. Otolaryngol Head Neck Surg 2020; 164:37-48. [DOI: 10.1177/0194599820933209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives To investigate the existing published evidence supporting the role of laryngopharyngeal reflux (LPR) in the development of the select nonfunctional laryngeal diseases of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections Data Sources PubMed, Cochrane Library, and Scopus. Review Methods A systematic review was performed by 3 independent investigators for studies providing information about the prevalence and role of LPR in the development of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed with PRISMA criteria. Results Of the 64 relevant publications, 27 clinical and 4 basic science studies were included. Ten studies used objective reliable examinations for LPR diagnosis (eg, dual- or triple-probe or oropharyngeal pH monitoring, multichannel intraluminal impedance–pH monitoring, or pepsin detection). According to the bias analysis and the results of studies, the association between LPR and laryngotracheal stenosis, leukoplakia, laryngeal papillomatosis, or vocal fold granuloma remains poorly demonstrated. There is a notable heterogeneity among included studies regarding their inclusion criteria, diagnostic methods, and clinical outcome evaluation. Although some experimental findings support the involvement of bile salts and other gastroduodenal proteins active in alkaline pH, no included clinical studies assessed the role of nonacid and mixed reflux through multichannel intraluminal impedance–pH monitoring. Conclusion The involvement of LPR in the development of leukoplakia, laryngotracheal stenosis, vocal fold granuloma, and laryngeal papillomatosis is currently not demonstrated. The potential relationship between LPR and these select nonfunctional laryngeal diseases must be confirmed through future clinical and experimental studies considering acid, nonacid, and mixed LPR.
Collapse
Affiliation(s)
- Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Stéphane Hans
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Christian Calvo-Henriquez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jonathan M. Bock
- Division of Laryngology and the Professional Voice Department of Otolaryngology and Communication Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas L. Carroll
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Barrena BG, Miller TM, Nelson BL. Laryngeal Contact Ulcer. Head Neck Pathol 2020; 14:1032-1035. [PMID: 32383044 PMCID: PMC7669920 DOI: 10.1007/s12105-020-01167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/27/2022]
Abstract
A 47-year-old man presented to the otolaryngology service with complaint of 6 months of intermittent globus sensation. He reported constant throat clearing and subjective lowering of his voice. Flexible nasolaryngoscopy revealed a large pedunculated mass originating from the left vocal process of the arytenoid, lying superior to the vocal fold. The patient was treated conservatively with an anti-reflux regiment and speech language therapy for 2 months, however he noted marginal worsening in voice over the proceeding interval with an increasing raspy quality. He underwent suspension microlaryngoscopy with biopsy. Microscopic examination demonstrated mucosal epithelium with surface ulceration and considerable fibrinoid necrosis, a mixed inflammatory infiltrate, and abundant granulation tissue with reactive endothelial cells. The diagnosis of laryngeal contact ulcer was rendered. The patient was treated with KTP (potassium titanyl phosphate) laser ablation and corticosteroid microinjection; he tolerated the procedures well and on follow-up noted reduced cough, improving voice quality and no residual dysphagia.
Collapse
Affiliation(s)
- Benjamin G Barrena
- Department of Anatomic Pathology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134-5000, USA.
| | - Tanner M Miller
- Department of Anatomic Pathology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134-5000, USA
| | - Brenda L Nelson
- Department of Anatomic Pathology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134-5000, USA
| |
Collapse
|
23
|
Price A, Lawson S, Flannigan C. Vocal cord granulomas diagnosed on reviewing videolaryngoscopy images. Arch Dis Child 2020; 105:381. [PMID: 30617122 DOI: 10.1136/archdischild-2018-316160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Alison Price
- PICU, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Sara Lawson
- Neonatal Intensive Care Unit, Royal Jubilee Maternity Hospital, Belfast, UK
| | | |
Collapse
|
24
|
Managing Otolaryngologic Complications in Cardiothoracic Surgery. Ann Thorac Surg 2020; 110:676-683. [PMID: 31982445 DOI: 10.1016/j.athoracsur.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiothoracic procedures are often lifesaving operations, and because of their complexity they are not without complications. Although major complications are often recognized and treated immediately, there are many less commonly identified complications that can and frequently should be addressed by otolaryngology colleagues during a patient's hospital course. METHODS This comprehensive review describes otolaryngologic complications of cardiac and thoracic surgery. RESULTS Dysphonia, dysphagia, stridor, tracheotomy hemorrhage, and pharyngeal tear are all complications of cardiothoracic procedures. Indications for treatment and treatment options are reviewed. The impact on quality of life and long-term morbidity is also discussed. CONCLUSIONS Otolaryngologic complications are common after cardiothoracic procedures. An otolaryngologist should be asked to evaluate a patient with dysphonia, dysphagia, or stridor while the patient is an inpatient. Patients experiencing persistent or nonacute problems should be referred to otolaryngologists to discuss more long-term interventions.
Collapse
|
25
|
Assessing the utility of non-surgical treatments in the management of vocal process granulomas. The Journal of Laryngology & Otology 2020; 134:68-73. [PMID: 31918788 DOI: 10.1017/s0022215119002524] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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.
Collapse
|
26
|
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.
Collapse
|
27
|
Chang W, Xu W, Cheng L. Treatment of Laryngeal Contact Granuloma: Surgical Therapy or Conservative Treatment. ORL J Otorhinolaryngol Relat Spec 2019; 81:348-353. [PMID: 31694031 DOI: 10.1159/000503975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Despite the fact that there are many treatment alternatives, laryngeal contact granuloma has a high tendency of persistence, spontaneous disappearance without treatment, and recurrence. A comparison of the effects of conservative treatment and surgical therapy on laryngeal contact granuloma was made in a retrospective review. METHODS A total of 124 patients with laryngeal contact granuloma were divided into 2 groups according to treatment: simple surgical excision (n = 36) and conservative treatment (n = 84). Additionally, the reflux finding score (RFS) and the reflux symptom index (RSI) were utilized to assess the disease. RESULTS A total of 124 patients, with a median age of 48.5 years, ranging from 9 to 74 years, were recruited (107 male, 17 female). According to the diagnostic criteria for laryngeal reflux (RSI >13 or RFS >7), there were 67 cases, accounting for 54.03% of the total. Surgery was effective in 15 patients (15/36, 41.67%), and conservative treatment was effective in 62 patients (62/84, 73.81%). The 2 groups had statistically significant differences. CONCLUSIONS Conservative treatment, which is a comprehensive anti-reflux therapy, is better than surgical therapy and plays an important role in the treatment of laryngeal contact granuloma.
Collapse
Affiliation(s)
- Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China,
| | - Liyu Cheng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
28
|
Song JG, Cho WH, Ji SM, Park JH, Kim SK. Laryngeal granulomas in patients after two-jaw surgery - Four cases report. Anesth Pain Med (Seoul) 2019; 14:489-493. [PMID: 33329782 PMCID: PMC7713798 DOI: 10.17085/apm.2019.14.4.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it. Case We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature. Conclusions There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.
Collapse
Affiliation(s)
- Jae Gyok Song
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Won Ho Cho
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Mi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jeong Heon Park
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Seok Kon Kim
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
29
|
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.
Collapse
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.
| |
Collapse
|
30
|
Evarts M, Romak J, Sataloff RT. Nonarytenoid laryngeal granulomas. EAR, NOSE & THROAT JOURNAL 2019; 97:272-277. [PMID: 30273424 DOI: 10.1177/014556131809700914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marissa Evarts
- Department of Otolaryngology and Facial Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | | | | |
Collapse
|
31
|
Wu J, Jiang T, Wu Y, Ding L, Dong L. Laryngeal granuloma occurring after surgery for laryngeal cancer treated by surgical removal and immediate post-operative radiotherapy: A case report. Medicine (Baltimore) 2019; 98:e17345. [PMID: 31574876 PMCID: PMC6775417 DOI: 10.1097/md.0000000000017345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONAL Laryngeal granulomas are benign lesion that rarely occurs after surgery of laryngeal cancer. Until now there has not been standard treatment for it. PATIENT CONCERN The patient was diagnosed with laryngeal neoplasm one and half a month ago. Endoscopic low-temperature plasma knife in the radical excision of left vocal cord was performed under the general anesthesia. Postoperative histopathological examination confirmed left vocal cord tumor was highly differentiated invasive squamous cell carcinoma (SCC). Then the patient suffered unexplained intermittent dyspnea which persisted nearly 1 month after the surgery. Laryngoscope examination showed granulation formation on the glottis. DIAGNOSES The patient was diagnosed with laryngeal granuloma 1 month after the surgery of laryngeal cancer. INTERVENTIONS The patient received resection of the laryngeal mass, and pathological examination confirmed the granuloma. Postoperative radiotherapy (RT) was performed within 24 hours after surgery. OUTCOMES The patient was followed up for 3 years after surgery and the laryngeal granuloma and laryngeal cancer did not recur during follow-up. The symptoms of intermittent dyspnea disappeared and a satisfactory outcome was achieved. LESSONS Usually for primary laryngeal granulomas, surgical treatment alone is not enough, because it is easy to relapse. RT within 24 hours after operation can significantly reduce the recurrence of laryngeal granuloma.
Collapse
Affiliation(s)
- Jingyi Wu
- Department of Radiotherapy
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan, China
| | | | - Yu Wu
- Department of Otolaryngology, First Hospital of Jilin University, Changchun
| | | | | |
Collapse
|
32
|
Oreški I, Gregurić T, Aras I, Mašić S, Stevanović S. Chain Formation of Laryngeal Granulomas on the Epiglottis After Iatrogenic Trauma. EAR, NOSE & THROAT JOURNAL 2019; 99:NP107-NP108. [PMID: 31266400 DOI: 10.1177/0145561319861385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ivan Oreški
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Tomislav Gregurić
- Department of Radiology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | | | - Silvija Mašić
- Department of Pathology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Siniša Stevanović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| |
Collapse
|
33
|
Martins RHG, Dias NH, Soares CSP, Gramuglia ACJ. Treatment of Laryngeal Granulomas. Int Arch Otorhinolaryngol 2019; 23:e322-e324. [PMID: 31360253 PMCID: PMC6660291 DOI: 10.1055/s-0039-1688456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/17/2019] [Indexed: 11/20/2022] Open
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.
Collapse
Affiliation(s)
- Regina Helena Garcia Martins
- Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
| | - Norimar Hernandes Dias
- Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
| | - Carlos Segundo Paiva Soares
- Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
| | - Andrea Cristina Joia Gramuglia
- Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
| |
Collapse
|
34
|
Kraimer KL, Husain I. Updated Medical and Surgical Treatment for Common Benign Laryngeal Lesions. Otolaryngol Clin North Am 2019; 52:745-757. [PMID: 31078305 DOI: 10.1016/j.otc.2019.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Benign laryngeal lesions are often the result of phonotraumatic forces on the vocal folds and thus classically are treated with a combination of voice therapy and phonomicrosurgical techniques to minimize inadvertent additional trauma. Newer management strategies expand on these techniques with the use of the pKTP laser as well as intralesional injections, both in the operating room and in the awake outpatient setting.
Collapse
Affiliation(s)
- Kristen L Kraimer
- Rush Medical College, 600 S. Paulina Street, Suite 202, Chicago, IL 60612, USA
| | - Inna Husain
- Rush University Medical Center, 1611 West Harrison, Suite 550, Chicago, IL 60612, USA.
| |
Collapse
|
35
|
Shoffel‐Havakuk H, Sadoughi B, Sulica L, Johns MM. In‐office procedures for the treatment of benign vocal fold lesions in the awake patient: A contemporary review. Laryngoscope 2018; 129:2131-2138. [DOI: 10.1002/lary.27731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Hagit Shoffel‐Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Sackler Faculty of MedicineTel‐Aviv University Israel
| | - Babak Sadoughi
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical College/New York Presbyterian Hospital New York New York
| | - Lucian Sulica
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical College/New York Presbyterian Hospital New York New York
| | - Michael M. Johns
- USC Voice Center, Department of Otolaryngology Head and Neck SurgeryUniversity of Southern California Los Angeles California U.S.A
| |
Collapse
|
36
|
Rimoli CF, Martins RHG, Catâneo DC, Imamura R, Catâneo AJM. Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis. Braz J Otorhinolaryngol 2018; 84:781-789. [PMID: 29699879 PMCID: PMC9442835 DOI: 10.1016/j.bjorl.2018.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Laryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment. OBJECTIVE To describe the effectiveness of different treatment modalities for primary or recurrent laryngeal granulomas resulting from endotracheal intubation. METHODS Systematic review and proportional meta-analysis. Eligibility criteria - experimental or observational studies with at least five subjects. Outcomes studied - granuloma resolution, recurrence, and time for resolution. Databases used - Pubmed, Embase, Lilacs, and Cochrane. The Stats Direct 3.0.121 program was used. RESULTS Six studies were selected, with 85 patients. The treatments registered were: antireflux therapy, speech therapy, anti-inflammatory drugs, steroids, antibiotics, zinc sulfate and surgery. 85 patients from six studies had primary treatment: surgery±associations (41 patients), resolution chance 75% (95% CI: 0.3-100%, I2=90%), absolute relapse risk 25% (95% CI: 0.2-71%); medical treatment (44 patients), resolution chance 86% (95% CI: 67-97%); and absolute relapse risk 14% (95% CI: 3-33%). There was no significant difference between groups. Three studies, encompassing 19 patients, analyzed secondary treatment (failure or recurrence after primary treatment); three subjects presented new recurrence. The time needed to resolve the lesions varied from immediate, after surgery, to 23 months, for inhaled steroid. CONCLUSION There is no evidence of high quality that proves the efficacy of any treatment for laryngeal granulomas resulting from endotracheal intubation.
Collapse
Affiliation(s)
- Caroline Fernandes Rimoli
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil
| | - Regina Helena Garcia Martins
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil.
| | - Daniele Cristina Catâneo
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Departamento de Cirurgia, Botucatu, SP, Brazil
| | - Rui Imamura
- Universidade de São Paulo (USP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Antonio José Maria Catâneo
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Departamento de Cirurgia, Botucatu, SP, Brazil
| |
Collapse
|
37
|
Jang M, Basa K, Levi J. Risk factors for laryngeal trauma and granuloma formation in pediatric intubations. Int J Pediatr Otorhinolaryngol 2018; 107:45-52. [PMID: 29501310 DOI: 10.1016/j.ijporl.2018.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Intubation has been associated with laryngeal injury that often resolves spontaneously without complication. We present a case of a child intubated for less than 48 hours, who presented with dysphonia and intermittent dyspnea two months after intubation due to epiglottic and vocal process granulomas. This is unusual in that multiple granulomas were found in the posterior glottis and supraglottis after short-term intubation. Our objective was to determine if there are risk factors for developing persistent post-intubation sequelae, including the delayed presentation and unusual location of post-intubation granulomas in our case. STUDY DESIGN Case report and systematic literature review. METHODS Pubmed database, which is inclusive of MEDLINE, was used to perform a literature review with the search terms ((pediatric OR children OR neonatal OR infant) AND (laryngeal OR supraglottic) AND intubation AND (granuloma OR injury OR complication)). Only English language results were reviewed. Titles and abstracts from 379 results were reviewed. Full text was reviewed from all original studies which included human pediatric subjects and endoscopic examinations after endotracheal intubation. RESULTS In our case, laryngeal granuloma size reduced significantly after starting anti-reflux medications. The remainder was removed with laryngeal microdebrider with no recurrence at 3 weeks and 2.5 years post-operatively. Overall, 28 of the 379 studies reviewed identified evidence of laryngeal trauma due to intubation, however only 6 studies documented any type of supraglottic injury. Risk factors identified for developing post-intubation sequelae included intubation duration greater than 24 h; trauma to the larynx via various mechanisms including traumatic intubation, need for reintubation and tube changes, and increased movement while intubated; and presence of respiratory tract infection during intubation. CONCLUSION Trauma to the larynx during intubation should be avoided to minimize post-intubation injury in pediatric patients, by using appropriate intubation protocols, endotracheal tube size, and adequate sedation.
Collapse
Affiliation(s)
- Minyoung Jang
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Krystyne Basa
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jessica Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| |
Collapse
|
38
|
Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis C(CW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg 2018; 158:S1-S42. [DOI: 10.1177/0194599817751030] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Libby J. Smith
- University of Pittsburgh Medical, Pittsburgh, Pennsylvania, USA
| | - Marshall Smith
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peak Woo
- Icahn School of Medicine at Mt Sinai, New York, New York, USA
| | - Lorraine C. Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
39
|
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.
Collapse
|
40
|
Perkins EL, Basu S, Garcia GJM, Buckmire RA, Shah RN, Kimbell JS. Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics. Otolaryngol Head Neck Surg 2017; 158:511-519. [PMID: 29160160 DOI: 10.1177/0194599817742126] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Vocal fold granulomas are benign lesions of the larynx commonly caused by gastroesophageal reflux, intubation, and phonotrauma. Current medical therapy includes inhaled corticosteroids to target inflammation that leads to granuloma formation. Particle sizes of commonly prescribed inhalers range over 1 to 4 µm. The study objective was to use computational fluid dynamics to investigate deposition patterns over a range of particle sizes of inhaled corticosteroids targeting the larynx and vocal fold granulomas. Study Design Retrospective, case-specific computational study. Setting Tertiary academic center. Subjects/Methods A 3-dimensional anatomically realistic computational model of a normal adult airway from mouth to trachea was constructed from 3 computed tomography scans. Virtual granulomas of varying sizes and positions along the vocal fold were incorporated into the base model. Assuming steady-state, inspiratory, turbulent airflow at 30 L/min, computational fluid dynamics was used to simulate respiratory transport and deposition of inhaled corticosteroid particles ranging over 1 to 20 µm. Results Laryngeal deposition in the base model peaked for particle sizes 8 to 10 µm (2.8%-3.5%). Ideal sizes ranged over 6 to 10, 7 to 13, and 7 to 14 µm for small, medium, and large granuloma sizes, respectively. Glottic deposition was maximal at 10.8% for 9-µm-sized particles for the large posterior granuloma, 3 times the normal model (3.5%). Conclusion As the virtual granuloma size increased and the location became more posterior, glottic deposition and ideal particle size generally increased. This preliminary study suggests that inhalers with larger particle sizes, such as fluticasone propionate dry-powder inhaler, may improve laryngeal drug deposition. Most commercially available inhalers have smaller particles than suggested here.
Collapse
Affiliation(s)
- Elizabeth L Perkins
- 1 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Saikat Basu
- 1 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Guilherme J M Garcia
- 2 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,3 Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robert A Buckmire
- 1 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rupali N Shah
- 1 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julia S Kimbell
- 1 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
41
|
Koushik SS, Lott DG, Ramakrishna H. Bilateral vocal fold granulomas following double-lumen endotracheal tube placement. J Anaesthesiol Clin Pharmacol 2017; 33:420-421. [PMID: 29109654 PMCID: PMC5672537 DOI: 10.4103/joacp.joacp_231_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sarang S Koushik
- Department of Anesthesiology, Mayo Clinic, Mayo Clinic, Phoenix, Arizona, USA
| | - David G Lott
- Division of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Harish Ramakrishna
- Department of Anesthesiology, Mayo Clinic, Mayo Clinic, Phoenix, Arizona, USA
| |
Collapse
|
42
|
Dominguez LM, Brown RJ, Simpson CB. Treatment Outcomes of In-Office KTP Ablation of Vocal Fold Granulomas. Ann Otol Rhinol Laryngol 2017; 126:829-834. [DOI: 10.1177/0003489417738790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Laura M. Dominguez
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas, USA
| | - Raymond J. Brown
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas, USA
| | - C. Blake Simpson
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas, USA
| |
Collapse
|
43
|
Comparison of the effects of esomeprazole plus mosapride citrate and botulinum toxin A on vocal process granuloma. Am J Otolaryngol 2017; 38:593-597. [PMID: 28655420 DOI: 10.1016/j.amjoto.2017.01.039] [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: 10/09/2016] [Accepted: 01/16/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Vocal process granulomas have a high tendency for persistence despite many treatment alternatives. Anti-reflux medications or botulinum toxin A injections are the main current therapies. There are no studies that compare the effects on vocal process granuloma of proton pump inhibitors plus prokinetic agents with botulinum toxin A injections. STUDY DESIGN Prospective cohort study. METHODS Adult patients reporting to our outpatient department complaining of trachyphonia and/or abnormal pharyngeal sensations who were found to have contact granulomas. Patients were divided into two groups according to the treatment: esomeprazole with mosapride citrate (n=26) or botulinum toxin A injection (n=20). The reflux symptom index and reflux finding score determined by electronic fibrolaryngoscopy were utilized to assess efficacy. RESULTS Forty-six patients were recruited (43 male; 3 female). The mean age (range) was 48.3years (38-69) and the body mass index was 23.51kg/m2 (19.13-27.89). Laryngopharyngeal reflux disease diagnosed by RSI or RFS was found in 18 and 27 patients, respectively, and 18 diagnosed without laryngopharyneal reflux disease. Twenty patients (95%) were cured in the esomeprazole with mosapride citrate group and nine (45%) in the botulinum toxin A group. Eleven (55%) patients had recurrence after botulinum toxin A injection, with an average interval of 3.1months (range 1-6). The recorded symptoms after therapy resolved within 6months with a statistically significant improvement in the esomeprazole with mosapride citrate group. CONCLUSIONS Combined proton pump inhibitor plus prokinetic drug therapy plays a significant role in the treatment of vocal process granulomas or after surgery.
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Simovic S, Vulovic TS, Stojanovic J, Zivanovic S, Koravovic M. A Case Report of Female Patient with Laryngeal Granuloma. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2017. [DOI: 10.1515/sjecr-2017-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The aim of this case report is to present the laryngeal granuloma in 23 year old female patient. Case outline: The 23 year old female was admitted for examination, because of long lasting, progressive hoarseness. In anamnesis, we found that she has undergone general anesthesia for 8 times, in the early childhood. We performing direct laryngoscopy with complete otorhinolaryngologic examination, rigid endovideostroboscopy and the large granuloma of the larynx was found. Conclusions: Laryngeal granuloma of vocal cords affected mainly men, except for cases associated with laryngeal intubation. We should keep in mind that postintubation laryngeal granuloma might develop after tracheal intubation, so care must be taken to avoid the potential complication.
Collapse
Affiliation(s)
- Sladjana Simovic
- Department of Otorhinolaryngology , Health Centre Kragujevac , Kragujevac , Serbia
| | - Tatjana Sarenac Vulovic
- Clinic of ophthalmology , Clinical centre Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Jasmina Stojanovic
- Phoniatric department of ENT Clinic , Clinical centre Kragujevac , Kragujevac , Serbia
| | - Sandra Zivanovic
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Mladen Koravovic
- Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| |
Collapse
|
46
|
Martins RHG, do Amaral HA, Tavares ELM, Martins MG, Gonçalves TM, Dias NH. Voice Disorders: Etiology and Diagnosis. J Voice 2016; 30:761.e1-761.e9. [DOI: 10.1016/j.jvoice.2015.09.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/29/2015] [Indexed: 11/16/2022]
|
47
|
Ogawa M, Hosokawa K, Iwahashi T, Inohara H. The results of Kaplan-Meier and multivariate analyses of etiological factors related to the outcome of combined pharmacological therapy against laryngeal granuloma. Acta Otolaryngol 2016; 136:1141-1146. [PMID: 27328639 DOI: 10.1080/00016489.2016.1193891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONCLUSIONS The present results indicate that the diagnosis of gastroesophageal reflux disease (GERD) is an independent etiological factor predicting retardation of the resolution of laryngeal granuloma. OBJECTIVES To assess the effects of combined usage of an inhaled corticosteroid plus tranilast and/or a proton pump inhibitor on the size of granulomatous lesions, and to reveal etiological factors related to the outcome using the Kaplan-Meier method and a subsequent multivariate analysis. METHODS Sixty-two patients with laryngeal granuloma were enrolled. An inhaled corticosteroid plus tranilast (300 mg/day) and rabeprazole (20 mg/day) were administered to all of the patients, and only to those diagnosed to have GERD, respectively. The size of granulomatous lesion was measured for each patient at the initial visit and every 4 weeks. At 48 weeks, the Kaplan-Meier plots for lesion disappearance rate were compared between groups with and without each of the etiological factors, followed by Cox proportional-hazards regression. RESULTS The 48-week lesion disappearance rates for the whole population were 82.3%. Although the Kaplan-Meier analysis exhibited significant differences between patients separated by GERD diagnosis, phonotrauma, and habitual smoking, only GERD were identified as a real independent etiological factor affecting the resolution of the lesion by a multivariate analysis using Cox's proportional-hazards regression.
Collapse
|
48
|
Schneider GT, Vaezi MF, Francis DO. Reflux and Voice Disorders: Have We Established Causality? CURRENT OTORHINOLARYNGOLOGY REPORTS 2016; 4:157-167. [PMID: 28163985 DOI: 10.1007/s40136-016-0121-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A trend of attributing abnormal voice changes to reflux has gained momentum among medical professionals over the last few decades. Evidence supporting the connection between reflux and voice and the use of anti-reflux medication in patients with dysphonia is conflicting and deserves careful examination. In the current health care environment, it is important that medical decisions be based on science rather than anecdote and practice patterns. The goal of this review is to investigate the evidence linking reflux and voice changes. Specifically, this association will be examined in the context of the Bradford-Hill criteria to determine what evidence exists for a causal relationship between this exposure (reflux) and outcome (voice change).
Collapse
Affiliation(s)
- G Todd Schneider
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David O Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Surgical Quality and Outcomes Research, Center for Population Sciences, and Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
49
|
In-Office Excision En Masse of a Vocal Process Granuloma Using the Potassium-Titanyl-Phosphate Laser. J Voice 2016; 30:93-5. [DOI: 10.1016/j.jvoice.2014.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/12/2014] [Indexed: 11/22/2022]
|
50
|
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.
Collapse
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..
| |
Collapse
|