Prognosis of patients with laryngeal contact granuloma: Development and validation of RCGSG score

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.

[The effect of surgical resection on the treatment of idiopathic laryngeal contact granuloma]

Objective:The aim of this study is to investigate the effect of surgical resection of idiopathic laryngeal contact granuloma on the follow-up treatment. Methods:From April 2014 to December 2019, the clinical data of 390 male patients with idiopathic laryngeal granuloma treated were analyzed retrospectively. The patients were divided into the group with history of surgical resection （172 patients） and the group without surgical resection history （218 patients）, and then both received the combined therapy. The treatment efficacy of the two groups were compared. Results:By the end of 6 months after beginning the combined therapy, the total efficacy rate of the patients with a history of surgery was 71.5%（123/172）, and that in patients without a history of surgery was 97.7% （213/218）. The difference between the two groups was statistically significant（Z=-7.828, P=0.0001）. Among the cured patients, the cure time of patients without the surgery history was shorter than patients with surgery history（Z=-4.441, P=0.0001）. Conclusion:Surgical treatment of laryngeal contact granuloma increases the difficulty of follow-up treatment, so surgical treatment is not recommended for newly diagnosed patients with laryngeal contact granuloma.

[Relationship between laryngopharyngeal reflux and calcification of arytenoid cartilage in male patients with idiopathic laryngeal contact granuloma]

Objective:To investigate the relationship between laryngopharyngeal reflux and arytenoid cartilage calcification in male idiopathic laryngeal contact granuloma. Method:The clinical data of 92 male patients with idiopathic laryngeal contact granuloma who had the thin laryngeal CT scan images and laryngeal reflux symptom index（RSI） scale data before treatment were analyzed retrospectively. The effect of laryngopharyngeal reflux on the calcification of arytenoid cartilage in laryngeal contact granuloma patients was analyzed by Chi-square statistics with SPSS 16.0 software. Result:Among the 92 patients, 44 patients with RSI>13（47.83%） and 48 patients with RSI≤13（52.17%）. Unilateral granuloma was found in 87 cases（94.57%） and bilateral granuloma in 5 cases（5.43%）. A total of 97 sides of the diseased side, there were 87 sides of arytenoid cartilage with calcification（89.69%） and 10 sides without calcification（10.31%）. Among the patients with RSI>13, there were 45 sides of arytenoid cartilage with calcification（45/46, 97.83%） and one side without calcification（1/46, 2.17%）, and in the patients with RSI≤13, there were 42 sides of arytenoid cartilage with calcification（42/51, 82.35%） and 9 sides without calcification（9/51, 17.65%）. The calcification rate of arytenoid cartilage in patients with RSI>13 group was significantly higher than that in RSI≤13 group（χ²=4.701, P=0.030）. Conclusion:The calcification rate of arytenoid cartilage in male idiopathic laryngeal contact granuloma patients with laryngopharyngeal reflux is higher than that in patients without laryngopharyngeal reflux. Laryngopharyngeal reflux may aggravate or promote the inflammatory reaction of granuloma and accelerate the calcification of arytenoid cartilage.

[Current status of treatment of laryngeal contact granuloma]

Laryngeal contact granuloma, also known as vocal cord granuloma, is the non-neoplastic inflammatory granulation tissue occurring in the vocal cord around. The cause is unclear, morbidity and cure rate is low, the recurrence rate is high, leading to a poor clinical treatment. But some symptoms of the sound disorder, pharyngeal foreign body sensation seriously affect the quality of life of patients, increase the psychological burden of patients. With the increasing awareness of the disease, the deepening of the research, there have been different treatment methods. This paper reviews the previous literatures, and summarizes LCG treatment for the status.