A triple blind, placebo controlled, randomised controlled trial of betahistine dihydrochloride in the treatment of primary tinnitus.

OBJECTIVES: To evaluate the effectiveness of betahistine in the treatment of primary tinnitus. DESIGN: To evaluate the effectiveness of betahistine in the treatment of primary tinnitus. SETTING: Universidade estadual Paulista Julio de Mesquita Filho, Botucatu Medical School, São paulo, Brazil. PARTICIPANTS: Adult patients with primary tinnitus who had not undergone treatment for tinnitus in the last 6 months were included. Patients with profound sensorineural deafness, hearing aid users and patients with metabolic, neurological, psychiatric or decompensated cardiovascular diseases were excluded. STUDY GROUPS: in the betahistine group, patients received betahistine 24 mg every 12 h for 90 days; in the control group, patients received placebo tablets every 12 h for 90 days. MEAN OUTCOME MEASURES: Primary outcome measure: Tinnitus Handicap Inventory (THI). SECONDARY OUTCOME MEASURES: Clinical Global Impression Improvement (CGI-I) and a question of 'Yes' or 'No' to participants about their perception of improvement in symptoms. RESULTS: Of 284 participants initially identified, 62 were randomised (betahistine group n = 31; control group n = 31). Median age (IQR) 54 (48-60) years, with a balanced number of men and women. There was no difference in THI outcome between the study groups (median difference, -2 points; 95% CI, -8 to 6 points); the THI after the intervention was a median (IQR) 4 (-4 to 14) lower points in the betahistine group, and a median (IQR) 2 (-6 to 10) in the control group. There was no statistical difference in secondary outcome measures. Adverse events were mild and there was no statistical difference between groups. CONCLUSIONS: Betahistine dihydrochloride was ineffective in the treatment of primary tinnitus in adults.

Laryngeal Microsurgery for the Treatment of Vocal Nodules and Cysts in Dysphonic Children.

INTRODUCTION: Vocal nodules and cysts are frequent causes of infantile dysphonia. Vocal therapy is the first treatment. Microsurgery has restricted indications, especially for nodules. OBJECTIVE: To describe our experience with microsurgery for nodules and cysts in children. METHODS: Dysphonic children (aged 4-18 years) with the diagnosis of nodules and vocal cysts were initially selected. Of these children, only those were included who had undergone microsurgery. For nodules and cysts, the microsurgery was indicated in cases of failure of vocal therapy and in cases of voice worsening or doubts about the diagnosis. All children were submitted to auditory perceptual vocal analysis and videolaryngostroboscopy (before and after surgery, after 6 months). Surgical outcomes were: total improvement (disappearance of vocal symptoms and of the laryngeal lesions); partial improvement (partial improvement of symptoms and/or maintenance of lesions); no improvement (maintenance or worsening of the symptoms and/or persistence of the lesions). -Results: There were 78 children with vocal nodules and 27 children with vocal cysts. Surgery was indicated for 12 children with vocal nodules (15.4%) and 12 children with cysts (44.4%). Total improvement registered for nodules and cysts was 75 and 83.4%, respectively. Partial improvement for both lesions was 25 and 16.6%, respectively. CONCLUSION: The best outcome for laryngeal microsurgery in dysphonic children was for vocal cysts. So, we encourage laryngologists for this conduct in vocal cysts. The success of microsurgery for vocal nodules was lower, and in these cases voice therapy seems to be the best treatment.

Aging voice: presbyphonia.

Presbyphonia is a physiological process of aging voice that includes morphological changes in the coverage mucosa, muscle, and cartilage. We revised the morphological, endoscopic, and vocal acoustic changes that occur in presbyphonia and discussed some treatments proposed to minimize glottal incompetence and improve vocal performance of the elderly.

Tonsilar metastases of melanoma in an older person.

We presented a rare case of metastasis of melanoma in palatine tonsils alerting healthcare professionals to this diagnose in black oral lesions.

Clinical practice: vocal nodules in dysphonic children.

Common among children, vocal symptoms are a cause of concern for parents who seek elucidation of their diagnosis and treatment. Vocal nodules are the major cause of dysphonias in children and are related to vocal abuse. We conducted a literature review considering clinical, physiopathological, epidemiological, and histological aspects of vocal nodules, as well as diagnostic methods, highlighting the main studies addressing this issue. The controversial points of treatments were also discussed.

Comparative study of the behavior of p53 immunoexpression in smoking associated lesions: Reinke's edema and laryngeal carcinoma.

OBJECTIVE: To assess the behavior of the immunoexpression of protein p53 in Reinke's edema and laryngeal squamous cell carcinoma. STUDY DESIGN: retrospective. METHODS: we recovered the histological paraffin blocks of patients who were subjected to Reinke's edema and laryngeal squamous cell carcinoma surgery in 2000-2011. The paraffin blocks were cut into 3-µm sections; the specimens were prepared in silanized slides (one slide for each paraffin block) and subjected to immunohistochemical reaction according to the Avidin Biotin Peroxidase method. Monoclonal primary anti-p53 antibodies were used at 1:50 dilution. Slides were examined under a light microscope at different magnitudes and results were interpreted based on the degree of brown staining in the nuclei of epithelial cells and in the extent of the fragment by using a semi-quantitative score from 0 to 3. RESULTS: 67 slides of Reinke's edema and 60 slides of laryngeal squamous cell carcinoma were included. Scores 2 and 3 for staining of the nuclei of epithelial cells were recorded for 46 slides of Reinke's edema (68.65%) and for 57 slides of laryngeal squamous cell carcinoma (95%). As to the extent of the fragment, scores 2 and 3 were recorded for 74% slides of Reinke's edema and for 95% slides of carcinomas. CONCLUSION: the positive immunoexpression for protein p53, positive in 95% carcinomas and 74% Reinke's edemas, makes us aware of the possible preneoplastic condition of the latter lesion. Further studies are needed to identify and reveal the genetic changes that lead to these results.

Efficacy of Injectable Laryngoplasty With Hyaluronic Acid and/or Calcium Hydroxyapatite in the Treatment of Glottic Incompetence. Systematic Review and Meta-analysis.

BACKGROUND: Injectable laryngoplasty with hydroxyapatite and hyaluronic acid is frequently used for the treatment of glottic incompetence. The effectiveness of these substances is controversial due to the heterogeneity of studies. OBJECTIVES: To evaluate the effectiveness of the treatment for glottic incompetence using hydroxyapatite and hyaluronic acid. STUDY DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, PUBMED, LILACS, SCOPUS, EMBASE, Cochrane, clinicaltrials.gov, published and unpublished trials, Web of Science. ELIGIBILITY CRITERIA: Studies that evaluated vocal fold function before and after 4-6 weeks and 6 months of hydroxyapatite and hyaluronic acid injection in adults with glottic incompetence. EXCLUSION CRITERIA: studies with outcome, follow-up time or type of intervention outside the predetermined pattern or systematic review and meta-analysis. SYNTHESIS OF METHODS: Primary outcome - Maximum Phonation Time. Secondary outcomes - Voice Handicap Index (VHI)-30, Parameters G and B of GRBAS Scale. Outcomes were analyzed for mean differences with the corresponding 95% CI. RESULTS: Six hundred forty-four studies identified, 12 included (5 CaHA; 6 HA; 1 HA and CaHA). After 4-6 weeks the mean difference were: MPT (+5.86), IDV (-39.32), G (-1.14), and B (-1.46). After 6 months: MPT (+5.97), IDV (-30.13), G (-1.33), and B (-1.33). LIMITATIONS: Studies comparing injectable drugs are small, as well as the number of patients in each one, making the isolated comparison of substances difficult. CONCLUSIONS AND IMPLICATIONS: There is an evidence that the injectable substances HA and CaHA are effective in the treatment of glottic incompetence, however, it is important that more studies are carried out comparing the two substances.

Does Abrupt Weight Loss Caused by Bariatric Surgery Compromise the Voice in Women?

OBJECTIVE: To evaluate vocal symptoms, voice characteristics and videolaryngoscopy in obese women before and after bariatric surgery. METHODS: Obese patients (18 to 59 years old), candidates for bariatric surgery were recruited. Evaluation times: T1 (preoperative), T2 (after six months), T3 (after 12 months). Evaluated parameters: weight, height, body mass index, abdominal and neck circumference, vocal self-assessment, perceptual and acoustic vocal assessment, and videolaryngoscopy. RESULTS: A total of 37 obese women were included, average age 40.8 years. There was a decrease in anthropometric measurements between the preoperative assessment and after 12 months: weight (121.18 ± 15.4 kg; 77.1 ± 11.6 kg), BMI (46.6 ± 6.95 kg/m2; 30 ± kg/m2), abdominal circumference (128 ± 16.1; 99.1 ± 12.1), and neck circumference (41.1 ± 5.85; 36.6 ± 3.02). Gastroesophageal (21.6%) and vocal symptoms (27%) prevailed. No difference was identified in vocal self-assessment between the evaluations. In the acoustic analysis, f0 increased and the soft phonation index decreased. The perceptual analysis registered lower scores for the degree of dysphonia (G) and voice instability (I). The maximum phonation time values increased without changing the s/z ratio. Videolaryngoscopies showed a posterior middle cleft and improvement in the signs of reflux. CONCLUSIONS: Bariatric surgery led to an important and gradual decrease in anthropometric parameters. The voice became less hoarse, with higher pitch and more stable, with an improvement in maximum phonation time, however with slight breathiness. Such changes were not noticed by the patients.

Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment.

Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I - complete improvement of the lesion, outcome II - partial improvement, and outcome III - no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.

Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery.

Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.

DNA rare copy number alterations in Reinke's Edema.

INTRODUCTION: Reinke's Edema (RE) is a laryngeal lesion related to excessive tobacco smoking, voice overuse, and laryngopharyngeal reflux. Although the risk of malignancy has been considered low in literature, RE is classified among precancerous lesions. OBJECTIVES: We investigated DNA Copy Number Alterations (CNAs) in specimens of RE and its potential association with malignant progression. METHODS: We used array-based comparative genomic hybridization (aCGH, Agilent 4 × 180 K platform) to study eight RE cases. All patients were heavy tobacco users for at least 30 years, and none of them progressed to cancer in the follow-up (>8 years). Two RE presented mild dysplasia, one moderate dysplasia, and no histological alterations were found in the remaining five cases. CNAs were compared with the Database of Genomic Variants (DGV) and genes mapped on altered regions had their functions annotated. RESULTS: Six of eight patients showed different rare copy number alterations on chromosomes 2q37.3, 4q13.1, 4q13.3, 7q11.22, 10p14, and 13q34. A gain of the whole chromosome 8 were detected in one case. Of interest, four of eight RE cases showed copy number imbalances involving genes previously described in several tumor types (RASA3, COL6A3, LINC00707, LINP1, SMR3A, and SMR3B). CONCLUSION: The genomic imbalances herein found in RE have the potential to contribute to the phenotype but with limited or no risk of cancer. A long-term follow-up in a large series of patients could clarify the mechanisms involved in the malignant progression of RE.

Effect of Aging on the Vocal Muscle.

INTRODUCTION: Sarcopenia is a common and natural condition in the elderly, and leads to loss of muscle mass and function. In the presbylarynx there is atrophy of the vocal folds, however the degree of vocal muscle atrophy is poorly studied and the results are contradictory. AIMS: The aim of this study was to evaluate the effect of aging on the vocal muscle (thyroarytenoid muscle). METHODS: Thirteen larynxes removed during necropsy from 13 cadavers were included into two age groups: Control group - G1 (n5), between 25 and 40 years; Elderly Group - GI (n-8), aged 70 years or older. The vocal folds were dissected and prepared for scanning electron microscopy, ensuring a cross-section in the musculature area to allow measurements of muscle fiber parameters. Images were analyzed and photographed at different magnifications. Through the ImageJ software, ten distinct fields of each part were selected. Parameters studied:  area, perimeters and diagonals of the thyroarytenoid muscle bundles of both groups. RESULTS: The cross-sectional areas, perimeters and diagonals of the muscle fibers of the thyroarytenoid muscle of the elderly group were significantly smaller than those of the control group. CONCLUSION: We demonstrated that the vocal muscle is affected in the presbylarynx, with a reduction of its muscle fibers, corresponding to muscle atrophy. However, these findings may not be directly related to vocal symptoms because the patient may develop muscle compensatory mechanisms capable of reducing glottic insufficiency.

Sectorial Analysis of the Fibrous Matrix of Vocal Folds in the Elderly.

OBJECTIVE: to determine the sectorial concentration of fibrous matrix along the vocal folds of the elderly. METHODS: Thirteen fresh vocal folds were removed from 13 cadavers. The subjects were divided into two groups: control group (CG) - age range 25-40 years (n = 5), and elderly group (EG), aged ≥70 years (n-8). The vocal folds were separated according to regions in: anterior macula flava (AMF), posterior macula flava (PMF), medial region (M) and lateral region of the membranous vocal fold (L). The material was examined using a scanning electron microscope and 10 pictures per region were obtained at 1200x magnification. The area of fibrous matrix was quantified in both groups using the AVSOFT Biovew Program. RESULTS: Percentage (%) of fibrous matrix per region (%): AMF (EG = 86.78%; CG = 81.63%); PMF (EG = 88.19%; CG = 81.52%); M (EG = 84.92%; CG = 77.96%); L (EG = 83.93%; CG = 78.91%). Irregular distribution of a dense fibrous matrix was also more evident in the elderly's larynges in a qualitative assessments. CONCLUSION: A higher concentration of fibrous matrix was observed in the vocal folds of the elderly when compared to the control at all the studied regions. The greatest increase in the concentration of fibers in the medial portion of the body of the vocal folds is probably due to the phonatory stimulation. The macula flava remains functional even in the senile larynx.

Vocal Characteristics of Patients With Morbid Obesity.

INTRODUCTION: Obesity modifies vocal characteristics, causing abnormal fat deposition in the abdominal region and upper airways. For some authors the voice of the obese is not different from nonobese and the vocal symptoms are scarce; for others dysphonia in obese is reported by 70% of them and the voice becomes hoarse, breathy, and unstable. OBJECTIVE: To characterize the voice of patients with morbid obesity. METHODS: Two groups were included: Obese (n-27), aged between 26 and 59 years, selected for bariatric surgery; Control (n-27), matched in age, with ideal weight for height. PARAMETERS: Vocal self-assessment (Vocal Disadvantage Index-IDV and Quality of Life and Voice-QVV); Perceptual-auditory vocal evaluation (GRBASI scale), maximum phonation time; Acoustic vocal analysis and Videolaryngoscopic exams. RESULTS: In obese, the most frequent symptoms were gastroesophageal and hoarseness. The vocal self-evaluation did not record any relevant complaints in both groups. In obese, the perceptual-auditory voice evaluations indicated significant changes in R (roughness), B (breathiness), I (instability), and S (tension) parameters. Acoustic vocal analysis recorded changes in the noise-harmonic ratio (NHR) and soft phonation index (SPI) parameters. The videolaryngoscopy examinations showed, in control and obese groups, respectively: normal: 92.5% and 55.5%; posterior pachydermia: 11.1% and 33.3%; mid-posterior bowing: 0% and 7.4%; edema/congestion: 0% and 7.40%. CONCLUSION: The voice of the obese becomes discreetly hoarse, breathless, and unstable. The most frequent videolaryngoscopic findings in obese patients are hyperemia and edema of vocal folds and posterior pachydermia, related to acid laryngitis, secondary to gastroesophageal reflux.

An estimate of the incidence and prevalence of laryngeal papillomatosis in São Paulo State (Brasil).

BACKGROUND: Recurrent laryngeal papillomatosis, caused by the Human Papilloma Virus, has a significant economic impact worldwide and there are no epidemiological data of this disease in Brasil. OBJECTIVE: The objective of the study was to estimate the incidence and prevalence of laryngeal papillomatosis of some otorhinolaryngology centers in São Paulo State (Brasil). METHODS: A questionnaire containing data on the number of new and follow-up cases diagnosed with laryngeal papillomatosis was sent to the Otorhinolaryngology services (n=35) of São Paulo State (Brasil). RESULTS: A total of 20 otorhinolaryngology centers answered the questionnaire. Of these, the five largest regional health centers were selected as follows: Campinas (42 cities - 4,536,657 inhabitants), Sao Jose do Rio Preto (102 cities - 1,602,845 inhabitants), Ribeirão Preto (26 cities - 1,483,715 inhabitants), Bauru (68 cities - 1,770,427 inhabitants), and Sorocaba (47 cities - 2,478,208 inhabitants). The incidence and prevalence of each regional health centers were, respectively: Campinas (5.51;7.27), Sorocaba (2.02;6.86), São José do Rio Preto (1.87;7.49), Ribeirão Preto (11.46;22.92), and Bauru (3.95;7.91). CONCLUSION: The incidence and prevalence of the laryngeal papillomatosis of the five largest regional health centers of the interior of São Paulo State (Brasil) varied between 1.87 to 11.46 and 6.86 to 22.92 per 1,000,000 inhabitants, respectively for a total population of 11,871,852 inhabitants.

Clinical, histological and electron microscopic aspects of vocal fold granulomas.

UNLABELLED: Granulomas are bilateral and pediculated lesions of the vocal apophysis. Etiologies: intubation, reflux, trauma, vocal abuse, idiopathic origin. AIM: To analyze the clinical and morphological aspects of post intubation granulomas. METHODS: retrospective study of patients submitted to microsurgery for post intubation laryngeal granulomas seen at our Medical School starting in 2002. We analyzed: age, gender, indication and time of intubation, symptoms, videolaryngoscopic diagnosis and biopsy findings. Light microscopy was performed on all specimens, and electron microscopy on three of them. RESULTS: ten patients (7 females and 3 males), between the ages of 2 and 72 years, intubation time between 4h and 21 days. Hoarseness was a frequent symptom, starting in the first week following extubation. Histology shows mild epithelial hyperplasia, severe inflammation and vessel proliferation in the corion. Under SEM, the epithelium presented mild superficial desquamation. Under TEM, intracellular junctions showed widening with structural changes in the desmosomes. In the corion there were vessel proliferations, inflammation and fibroblasts with structural alterations. CONCLUSIONS: post intubation granulomas appear in any age and hoarseness is a frequent symptom. Morphological alterations occur in the corion as vessel proliferations, inflammation, and intracytoplasmatic alterations in fibroblasts suggesting cellular dysfunction and damage.

Laryngeal Web as a Possible Cause for Nonabsorption of Vocal Nodules in Boys After Puberty.

OBJECTIVES: Vocal nodules are frequent in children and tend to be reabsorbed after puberty, especially in boys. The aims of the present study were to analyze the progression of nodules in boys after puberty and to investigate the role of microweb in the persistence of these lesions. METHODS: Clinical and videolaryngoscopy evaluations were carried out in boys with vocal nodules treated between 2009 and 2016, followed up to the age of 17 years or until remission of symptoms and reabsorption of the nodules. Boys with vocal nodules who underwent regular vocal therapy are included in the study. The outcomes were remission of symptoms and of the nodular lesions. RESULTS: A total of 34 boys with vocal nodules were diagnosed, of which 21 completed follow-up. Mean age of the first evaluation was 9 years (5-11 years) and of end of treatment was 14 years (13-18 years). Mean number of videolaryngoscopy per child was five. After adolescence there was complete remission of symptoms and of the lesions in 15 children (71.4%), partial remission in four (19.0%), and no remission of symptoms and of the lesions in two cases. In these two, videolaryngoscopy identified the presence of microweb and nodules. CONCLUSIONS: Favorable reabsorption of the vocal nodules after adolescence was observed in the majority of the boys who underwent voice therapy; however, in two cases there was no remission of symptoms and of the lesions. The unfavorable course can be attributed to anterior laryngeal microwebs.

Laryngeal and vocal alterations after thyroidectomy.

INTRODUCTION: Dysphonia is a common symptom after thyroidectomy. OBJECTIVE: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. METHODS: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). RESULTS: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy n=40, total thyroidectomy n=88, thyroidectomy+lymph node dissection n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy+isthmectomy n=6; total thyroidectomy n=17; thyroidectomy+lymph node dissection n=9) and 2 superior laryngeal nerve (lobectomy+isthmectomy n=1; Total thyroidectomy+lymph node dissection n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21). CONCLUSION: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

Treatment of Laryngeal Granulomas.

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.