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.

Treatment of Laryngeal Contact Granuloma: Surgical Therapy or Conservative Treatment.

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.

Conservative Treatment versus Surgery for Laryngeal Contact Granuloma: A Prospective Study.

AIMS: To confirm the efficacy of conservative treatment for laryngeal contact granuloma and identify factors influencing treatment outcome. METHODS: In this prospective study, patients with laryngeal contact granuloma were divided into a group receiving conservative treatment and a group undergoing surgery. Efficacy was assessed by analyzing the complete response after a 48-week follow-up. The association of treatment outcome with clinical factors was then evaluated. RESULTS: In total, 61 patients, 43 in the group receiving conservative treatment and 18 in the group undergoing surgery, were analyzed, and the complete response rate was 72.1% and 38.9%, respectively. Both univariate analysis and multivariate analysis revealed that treatment modality (p1 = 0.015, p2 = 0.043), voice abuse (p1 = 0.010, p2 = 0.010), and the size of the granuloma (p1 = 0.031, p2 = 0.020) were significantly associated with the complete response of laryngeal contact granuloma. Kaplan-Meier curves showed that alcohol consumption (p = 0.031), voice abuse (p < 0.001), and granuloma size (p = 0.025) were significantly related to the complete response of conservative treatment. CONCLUSIONS: This prospective study strengthens the argument for conservative treatment (instead of surgery) as the first choice for laryngeal contact granuloma. The results also suggest that voice abuse, alcohol consumption, and the size of the granuloma may predict treatment outcome.

[A Clinical Study on 64 Cases of Laryngeal Granuloma].

Vocal process granulomas are mainly associated with vocal abuse, gastroesophageal reflux disease (GERD), or endotracheal intubation. In the present study, we evaluate the prognostic factors and the usefulness of a grading system in 64 patients with vocal process granulomas. We classified the granuloma which limited the vocal process of the arytenoid cartilage as grade I, and which originated from the vocal process but extended beyond the vocal process of the arytenoid cartilage as grade II, according to the grading system proposed by Wang CP, et al. First, we treated this disease with conservative treatments including a proton pump inhibitor, steroid inhalation, or voice therapy. Surgical treatment was reserved for failures of conservative treatments or when the diagnosis was in doubt. The overall post-surgical recurrence rate was 65.7%, and it was significantly higher in male than female patients, and in younger than older patients. The overall remission rate was 79.7%. A multivariate analysis revealed that Grade II was a significantly poor prognostic factor and the patients with BMI ≥23 or Age <60 had a tendency to have a poor remission rate. The grading system is useful for anticipating the prognosis in cases of vocal process granuloma.

Vocal process granulomas: a systematic review of treatment.

OBJECTIVES: Vocal process granulomas (VPGs) are benign laryngeal lesions with controversial treatment and a tendency to recur. There are several treatment options with unpredictable results, high recurrence rates, and disappointing long-term outcome. The aims of this article are to focus on evidence-based current treatment strategies for primary lesions and recurrences. DATA SOURCES: The data came from a systematic review of the literature. METHODS: Main outcome measures were recurrence rate, reduction, and/or complete resolution. Inclusion criteria included English literature, randomized and nonrandomized trials, prospective and retrospective studies, and primary and recurrent cases. Exclusion criteria included case reports, teaching reviews, and papers not focusing on treatment. RESULTS: The time frame of the included studies was from 1997 to 2012. There are 6 different treatment options (single or combined) for VPG. Antireflux medication is the mainstay treatment and when combined with lifestyle changes and voice therapy results in the lowest recurrence rate. "Bloodless" in-office or in-theater laser techniques appear to have lower recurrence rates when compared to traditional cold steel microlaryngoscopy techniques, especially for recurrences. CONCLUSIONS: There is level 2A evidence that antireflux treatment is the main treatment strategy for vocal process granulomas with surgery reserved only for failures of medical treatment or airway obstruction or when diagnosis is in doubt.

Surgery and proton pump inhibitors for treatment of vocal process granulomas.

The aim of this study was to analyze the outcomes of vocal process granulomas treated with surgery and proton pump inhibitors and to specify related factors of recurrence. The medical records of patients with diagnosis of vocal process granuloma between 2000 and 2012 were reviewed. All patients were treated with surgery and proton pump inhibitors for at least 1 month. Forty-one patients were reviewed; mean follow-up time was 45 months. There was no recurrence among the patients who had a recent history of intubation. The recurrence rates of contact granuloma was 38.7 %, and significantly related to the frequency of surgery (P = 0.042), but was not significantly associated with the history of acid reflux (P = 0.676) and vocal abuse (P = 0.447), lesion size (P = 0.203) or surgical techniques (P = 0.331). Surgery combined with proton pump inhibitors was partially effective for the vocal process granulomas, especially with intubated patients. However, repeat surgery for recurrent contact granuloma should be preceded with caution due to high recurrence rates.

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.

Updated Medical and Surgical Treatment for Common Benign Laryngeal Lesions.

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.

Diagnosis and Treatment of Benign Pediatric Lesions.

Dysphonia is common in pediatrics and affects individuals from infancy through their teenage years. Pediatric dysphonia has a variable impact on children, ranging from no impact to a severe social barrier. Although most etiologies are benign, potentially life-threatening causes must be ruled out by direct examination of the larynx. The most common benign lesions of the larynx in pediatrics are vocal nodules, vocal fold polyps, cysts, granulomas, ectasias, sulcus vocalis, and vascular lesions, including hemangioma and postcricoid cushion. Treatment of benign vocal lesions should be tailored to the individual patient and the perceived impact.

Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis.

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.

[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.

[Voice disorders in recurrent laryngeal granuloma dependend on GERD]. / Zaburzenia glosu w nawrotowym ziarniniaku krtani w przebiegu GERD.

The voice disorders in a case of recurrent laryngeal granuloma with chronic gastroesophageal reflux was described. There was emphasized necessity of complex treatment pharmacological and phoniatric, as well as there were pointed out some indications of microsurgery.

[Contact granuloma of the larynx].

The authors analyse the results of clinical examination of patients with contact granuloma of the larynx treated in Moscow and Erlangen (Germany) clinics. Etiology, pathogenesis of this disease and treatment policy are discussed.

Vocal process granuloma of the larynx-recognition, differential diagnosis and treatment.

The vocal process granuloma is a nonneoplastic lesion that most often develops in the vicinity of the posterior vocal cords, adjacent to the vocal process. It may be an ulcerated region of the cord, or it may manifest as a nodular polypoid lesion. Causative factors include gastroesophageal reflux, intubation trauma, and vocal abuse. This lesion may be mistaken on clinical or pathologic grounds for carcinoma, although thorough microscopic examination usually permits a correct diagnosis. Despite its name, vocal process granuloma is not a true granulomatous process in a pathologic sense (inasmuch as it lacks aggregates of mononuclear and multinucleated histiocytes)-rather, it is a reactive/reparative process, in which an intact or ulcerated squamous epithelium is underlaid by granulation tissue or fibrosis. Treatment of vocal process granuloma centers around conservative voice therapy, coupled with treatment of any underlying inciting cause (such as gastroesophageal reflux). While it may recur locally (particularly if the original inciting cause persists), vocal process granuloma has no premalignant potential.

Left ventricular hypertrophy with outflow tract obstruction-a complication of dexamethasone treatment for subglottic stenosis.

To our knowledge, this is the 1st reported case of steroid-induced obstructive cardiomyopathy in a child being treated for subglottic stenosis. As well, although born at 27 weeks, our patient was over 4 kg and 4 months of age (44 weeks corrected gestational age). This appears to be a phenomenon chiefly involving premature babies in the neonatal period with no reports of this occurring in patients greater than 40 weeks corrected gestational age. Signs of cardiac hypertrophy include tachycardia, new cardiac murmur, increased oxygen requirements, decreased urine output, and decreased peripheral perfusion. Diagnosis and eventual recovery was confirmed with serial echocardiograms. Knowledge of this serious side effect of dexamethasone will allow otolaryngologists to intervene early and prevent a potentially deadly complication.

Vocal process granuloma: clinical characterization, treatment and evolution.

UNLABELLED: Vocal process granuloma is a disease whose etiopathogenesis is not well defined. Therefore, its clinical and surgical treatment is not standardized and its therapeutic results depend on the hospital where it is seen. AIM: Aiming to characterize patients with vocal process granuloma treated in our hospital, the therapeutic approach used and clinical evolution. MATERIAL AND METHOD: We performed a retrospective review of records. RESULTS: We found more male vocal process granuloma, except when associated with laryngeal intubation. The most frequent related etiopathogenic factor was laryngeal-pharynx reflux, followed by laryngeal intubation and vocal abuse. Clinical management with proton-pump inhibitor (PPI), topical inhalant steroid and phonotherapy was enough for remission on 48.6% of the patients. Surgery for removal of the granuloma associated with clinical management was effective in 90% of the events. Later recurrences (more than one year) were noticed in five patients, suggesting that associated etiopathogenic factors should be held for a long time.

Treatment of vocal fold granuloma using botulinum toxin type A.

Contact granuloma of the vocal folds has been associated with abnormal use of the voice, and acid reflux may exacerbate the inflammatory process. Treatments have included voice therapy and antireflux measures. Surgical excision is considered in patients who do not respond to medical management. Localized injections of botulinum toxin type A (BOTOX) have been effective in patients with disorders of muscular control in the head and neck. In this study, granulomas resolved in six patients who underwent injection of the affected vocal folds. Botulinum toxin type A is probably successful because it prevents forceful closure of the arytenoids during phonation and coughing. Localized injection of this neurotoxin is promising both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates.

Teflon vocal fold augmentation: failures and management in 28 cases.

Although vocal fold augmentation by Teflon injection has been the mainstay of treatment for glottic insufficiency for three decades, the success and safety of this treatment have been overstated. Twenty-eight patients who manifested poor or complicated Teflon results between 1984 and 1991 were evaluated using acoustic, aerodynamic, videostroboscopic, perceptual, and subjective patient self-evaluation of voice, both before and after our management of these complications. Most of these had Teflon granulomas; subglottic overfilling was the most common condition. In most instances such management included microsurgical removal of the Teflon granuloma. Voice measures that were abnormal before correction tended to improve and move into the normal range, although the resultant voices were not totally normal. Degree of improvement varied depending on the Teflon-induced tissue changes and the methods of correction subsequently used. The worst results were in patients with scarring, atrophy, and bilaterally mobile vocal folds, for whom Teflon should never have been injected. Teflon injection should be reserved for those instances in which it is clearly indicated and the surgeon is skilled in the technique of intrafold injection.

Management of common voice problems: Committee report.

OBJECTIVE: This report provides the reader with a state-of-the-art update on a number of common voice problems that require phonosurgical intervention. STUDY DESIGN AND SETTING: This multiauthor review is not a position statement of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) and may reflect institutional preference and/or bias. It arose from a panel discussion at the AAOHNS meeting in 2000. RESULTS: We provide a review of the genesis and management of papillomatosis, dysplastic glottal epithelium, arytenoid granulomas, Reinke's edema, and vocal-fold paralysis. CONCLUSIONS AND SIGNIFICANCE: In the past decade, there has been a dramatic expansion of knowledge regarding a variety of voice disorders and associated treatment. There has been a convergence of basic science investigations in anatomy, physiology, and pathology with clinical trials of treatment, both surgical and nonsurgical. This information should provide the reader with current insight into critical management issues of the aforementioned disorders.

Teflon granuloma of the larynx: etiology, pathophysiology, and management.

Intralaryngeal Teflon injection for correction of unilateral vocal cord paralysis is known to produce a foreign body giant cell reaction. In our practice, we have seen increasing numbers of patients who had developed dysphonia related to Teflon injection. This patient series was reviewed, as were the surgical technique to correct this condition, voice results, and acoustic analysis of a subset of the patient series. We conclude that dysphonia, secondary to Teflon injection, can be either from overinjection of Teflon or inappropriate injection, or from the proliferative granulomatous response of the larynx to the Teflon. Our technique of laser incision into the superior aspect of the Teflon implant, followed by vaporization and preservation of a margin of mucosa of the cord medially, resulted in improved voice in 8 of 11 patients treated in this manner. Acoustic and aerodynamic analyses reveal significant deficits in vocal function that may persist after procedures used to correct this condition.