The effectiveness of various treatment approaches for laryngeal contact granulomas.

OBJECTIVES: To assess and compare the effectiveness of various treatment approaches for laryngeal contact granulomas (LCG). METHODS: A retrospective analysis was conducted on a cohort of 45 patients diagnosed with LCG at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to May 2023. Based on the treatment modalities administered, patients were categorized into three groups: acid suppression alone, hormone injection combined with acid suppression, and surgery combined with acid suppression. Subsequently, the study compared differences in treatment efficacy and average healing time among these three groups, using various indicators. RESULTS: The findings indicate that the granuloma size in LCG patients with hoarseness (0.126, 95% CI 0.087-0.288) was significantly greater compared to LCG patients without hoarseness (0.047, 95% CI 0.014-0.083) (P = 0.001). However, there were no significant variations in age, morphology (unlobulated/lobulated), laterality ratio (left/right), sex ratio (male/female), history of tracheal intubation (non-intubation/intubation), and RFS score (RFS > 7/RFS ≤ 7) (P > 0.05), regardless of the presence of hoarseness symptoms. At the treatment observation endpoint of 3 months, the curative ratio in the group receiving hormone injection combined with acid suppression was found to be significantly higher compared to the group receiving acid suppression alone (P = 0.018). In addition, the average healing time of patients in the hormone injection combined with acid suppression group was notably shorter than that of the acid suppression alone group (P = 0.007). CONCLUSIONS: The combination of hormonal injections and acid suppression may enhance the curative ratio and expedite the healing time of LCG.

Bilateral Vocal Fold Granuloma and Anterior Glottic Web After Papilloma Excision.

We present a case of delayed vocal process granulomas and anterior glottic web after treatment of vocal fold papillomas with a laryngeal microdebrider and CO2 laser ablation. This case highlights a risk of vocal fold granuloma in the setting of recurrent respiratory papillomatosis and microdebrider use, warranting close follow-up and consideration of prophylactic voice therapy, anti-reflux medications, and steroid injection in cases of violation of vocal cord epithelium.

Thyroarytenoid botulinum toxin injection for refractory laryngeal contact granuloma.

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.

[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.

Factors for Predicting the Therapeutic Efficacy of Laryngeal Contact Granuloma.

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.

A Case of Laryngeal Granulomas After Oral and Maxillofacial Surgery With Prolonged Intubation.

Laryngeal granuloma development can be a postoperative complication of laryngeal trauma or irritation resulting from general anesthesia and endotracheal intubation. These rare benign lesions are located primarily over the cartilaginous portions of the larynx, particularly the vocal processes of the arytenoids. Airway manipulation during the intubation process and prolonged intubation periods can be contributing factors to intubation-related laryngeal granulomas, which may manifest 1 to 4 months after intubation. The patient in this case was a female who returned with complaints of throat pain without hoarseness or sensations of a "lump in her throat" 3 months following surgery, during which she was intubated with a 7.0-mm nasotracheal tube for 30 hours, likely contributing to her bilateral laryngeal granulomas. The patient underwent successful conservative medical management consisting of a proton pump inhibitor and an inhaled corticosteroid.

Vocal cord granuloma after transoral thyroidectomy using oral endotracheal intubation: two case reports.

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.

Short-term outcome of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females.

OBJECTIVE: To evaluate the short-term efficacy of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females. METHODS: A total of 14 female patients with laryngeal contact granuloma treated in our outpatient department from November 2017 to January 2020 were included in the study. Inspiratory-phase laryngoscopy images were collected before treatment and 1 month after each injection, and the lesion size was measured and evaluated with ImageJ software. RESULTS: Two patients achieved complete remission after one injection, with a percent reduction of 100%. After two injections, 4 patients achieved complete remission, with a percent reduction ranging from 96% to 100%. After 3 injections, 4 patients achieved complete remission (including one patient with bilateral lesions), and the percent reduction ranged from 95% to 100%. Three patients achieved incomplete remission, with a percent reduction of 46%, 55%, and 81%, respectively. In one case, there was no remission, and the granuloma increased in size after treatment. CONCLUSION: In women with laryngeal contact granuloma, transcutaneous glucocorticoid injection therapy can quickly resolve the granuloma in a short period.

Operative and Conservative Management of Laryngeal Contact Granuloma: A Network Analysis and Systematic Review.

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.

Machine Learning in Laryngoscopy Analysis: A Proof of Concept Observational Study for the Identification of Post-Extubation Ulcerations and Granulomas.

OBJECTIVE: Computer-aided analysis of laryngoscopy images has potential to add objectivity to subjective evaluations. Automated classification of biomedical images is extremely challenging due to the precision required and the limited amount of annotated data available for training. Convolutional neural networks (CNNs) have the potential to improve image analysis and have demonstrated good performance in many settings. This study applied machine-learning technologies to laryngoscopy to determine the accuracy of computer recognition of known laryngeal lesions found in patients post-extubation. METHODS: This is a proof of concept study that used a convenience sample of transnasal, flexible, distal-chip laryngoscopy images from patients post-extubation in the intensive care unit. After manually annotating images at the pixel-level, we applied a CNN-based method for analysis of granulomas and ulcerations to test potential machine-learning approaches for laryngoscopy analysis. RESULTS: A total of 127 images from 25 patients were manually annotated for presence and shape of these lesions-100 for training, 27 for evaluating the system. There were 193 ulcerations (148 in the training set; 45 in the evaluation set) and 272 granulomas (208 in the training set; 64 in the evaluation set) identified. Time to annotate each image was approximately 3 minutes. Machine-based analysis demonstrated per-pixel sensitivity of 82.0% and 62.8% for granulomas and ulcerations respectively; specificity was 99.0% and 99.6%. CONCLUSION: This work demonstrates the feasibility of machine learning via CNN-based methods to add objectivity to laryngoscopy analysis, suggesting that CNN may aid in laryngoscopy analysis for other conditions in the future.

Comparison of PPI and combined treatment in the treatment of recurrent laryngeal contact granuloma.

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.

[Clinical analysis of 46 cases of female laryngeal contact granuloma].

Objective:To investigate the clinical characteristics, diagnosis and treatment of female laryngeal contact granuloma. Method:The clinical data of 46 female patients with laryngeal contact granuloma diagnosed and treated by our clinical team from March 2011 to October 2018 were retrospectively analyzed. Result:The age of the 46 patients ranged from 5 to 58 years old, with an average age of 36.76 years old. The causes of the contact granulomas historically may be the result of intubation in 33 cases, laryngopharyngeal reflux in 8 cases, chronic cough in 2 cases, laryngopharyngeal reflux combined with chronic cough in 2 cases, and voice abuse and excessive clearing of the throat in one case. All patients were followed up for at least half a year, and all of them were cured. Among the 6 patients with large lesions who underwent surgical treatment, 3 relapsed within 3 months, PPI treatment was performed for 2 to 6 months after recurrence, and no recurrence was observed during follow-up, with an average course of treatment of （1.67±2.34） months. All the 11 patients who received corticosteroid injections recovered after 1 to 7 injections, with a median of 3 injections, and an average course of treatment of （2.64±1.69） months. All the 13 patients with oral PPI were cured, with an average course of treatment of （4.15±2.76 ）months; No recurrence was found in the follow-up of 16 patients with conservative treatment under regular observation, with an average course of treatment of （5.88±3.76） months. The difference in cure time between the intervention group （30 cases） and the observation group （16 cases） was statistically significant, and the cure time of the intervention group was shorter than that of the observation group （H=11.902, P=0.008）. Conclusion:Female patients with laryngeal contact granuloma are common after intubation, and various treatments or conservative observation can achieve good results, and treatment intervention may shorten the cure time.

[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.

A 51-Year-Old Man With Hoarseness of Voice.

CASE PRESENTATION: A 51-year-old nonsmoking man presented to his general practitioner with a primary complaint of 4 months of progressive hoarseness, and was subsequently referred to an otolaryngologist. He had no relevant medical or surgical history. He did not take any chronic medications or supplements. He was born in the Dominican Republic and moved to New York City when he was 36 years old. He worked in construction. In his spare time, he would return to his home country. The patient was a lifelong nonsmoker and reported no alcohol consumption. He denied shortness of breath, cough, sputum expectoration, fevers, chills, and night sweats.

Spontaneous Giant Laryngeal Granuloma in the Absence of Laryngeal Injury.

The etiology of laryngeal granuloma can typically be attributed to endotracheal intubation, vocal abuse, or gastroesophageal reflux disease. There is a strong male predominance, except in cases due to intubation, where incidence is higher in women. We report a case of spontaneous development of multiple granulomas in a female with no history of intubation who presented with hoarseness and massive bilateral supraglottic masses obscuring her glottis. The disparity between the massive lesions and asymptomatic reflux highlights the need for further research in the pathophysiology of laryngeal granulomas.

Vocal fold granulomas in six brachycephalic dogs: clinical, macroscopical and histological features.

Vocal cord granulomas are rarely observed in brachycephalic breeds but often reported in humans as contact granulomas. Six French bulldogs were included in this retrospective descriptive study. Endoscopic laryngeal examinations were performed on all dogs under general anaesthesia. Vocal cord lesions were exclusively unilateral, exophytic, approximately 3-mm wide ulcerated mucosal nodules, arising from the vocal cord. Histopathological examination mainly revealed chronic inflammatory changes on the laryngeal epithelium which were consistent with laryngeal granulomas described in humans, except for the location: vocal cord in dogs versus vocal process in humans. In humans, granulomas result from chronic physical or chemical insult to laryngeal mucosa (chronic cough or throat clearing, vocal abuse, gastro-esophageal reflux). In brachycephalic breeds, chronic inspiratory efforts and air turbulences and gastro-esophageal reflux are suspected to result in chronic laryngeal inflammation.

Unusual extra-podal fungal mycetoma with black grains in a Senegalese child.

Mycetoma remains endemic in the tropical and subtropical regions of the "mycetoma belt" including Senegal. It affects more commonly young men in the age group of 20 to 40 years. The foot represents the most commonly affected site. The most common extra-podal localizations are leg, knee, buttocks, hand and arm. We report an exceptional case of cervical fungal mycetoma that occurred in a 13-year-old Senegalese child. He consulted for a cervico-submandibular tumefaction with multiple sinuses and black grains discharge evolving since 6 years, associated to laryngeal dyspnoea. Mycological examination with culture isolated Madurella mycetomatis. Cervical CT Scan showed bone and soft tissue invasion. Terbinafine alone was administered. During the evolution, tracheotomy was performed following the aggravation of the laryngeal disorders. Death from severe sepsis occurred after 8 months of evolution. The particularities of our case are the occurrence of fungal mycetoma in a child, the cervical localization and the difficulties of therapeutic management largely due to the diagnostic delay.

Evaluation of narrow band imaging in the assessment of laryngeal granuloma.

Laryngeal granulomas belong to common complications following trans-oral laser microsurgery (TLM). The aim of this study was to evaluate NBI in the differentiation between granuloma-like lesions and local tumor recurrence. 154 consecutive patients after TLM due to early laryngeal cancer were enrolled. In the group, a monthly follow-up including NBI endoscopy was performed. Moderate and severe dysplasia, carcinoma in situ and invasive cancer were defined as positive histology, laryngeal granuloma and other benign laryngeal lesions as negative histology and premalignant lesions as suspicious histology. In 47/154 (31%) cases, granuloma-like lesion (GLL) was found. Patients with GLL were divided into two groups based on the NBI classification. In all patients, the microvascular pattern in NBI was compared with the final histology. In group A, with suspicious, perpendicular vessels, 13/13 (100%) samples were positive. In group B, with normal vascular pattern 3/34 (9%) samples were positive and 31/34 (91%) samples were negative. There was a significant correlation between the positive NBI vascular pattern and the final histology (p = 0.00001). Sensitivity, specificity, accuracy of NBI were as follows: 81%, 100%, 94%, respectively.Based on our results, NBI can reliably differentiate between postoperative laryngeal granuloma and local tumor recurrence. In such a manner, this method is very helpful in the follow-up of tumor patients.