Treatment of Laryngeal Granulomas

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 (1month), proton pump inhibitor, omeprazole 40 mg/day (2months), 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.

Laryngeal granulomas in patients after two-jaw surgery: Four cases report

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.

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

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%, I 2 = 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.

Resumo: Introdução: Granulomas laríngeos pós-intubação são lesões laríngeas benignas, porém recorrentes. Não há um consenso na literatura em relação ao seu tratamento. Objetivo: Descrever a eficácia de diferentes modalidades de tratamento para granulomas laríngeos primários ou recorrentes resultantes da intubação endotraqueal. Método: Estudo-revisão sistemática e metanálise proporcional. Critérios de elegibilidade: estudos experimentais ou observacionais com pelo menos cinco indivíduos. Desfechos estudados: resolução do granuloma, recorrência e tempo de resolução. Bases de dados usadas: Pubmed, Embase, Lilacs e Cochrane. Foi usado o software Stats Direct 3.0.121. Resultados: Foram selecionados seis estudos, com 85 pacientes. Os tratamentos registrados foram: terapia antirrefluxo, terapia da voz, medicamentos anti-inflamatórios, esteroides, antibióticos, sulfato de zinco e cirurgia. Receberam tratamento primário 85 pacientes de seis estudos: cirurgia ± associações (41 pacientes), chance de resolução de 75% (IC 95% 0,3% a 100%, I2 = 90%) e risco absoluto de recorrência de 25% (IC 95%: 0,2% a 71%); tratamento clínico (44 pacientes), chance de resolução de 86% (IC 95%: 67% a 97%) e risco absoluto de recorrência de 14% (IC 95%: 3% a 33%). Não houve diferença significante entre os grupos. Três estudos, que abrangeram 19 pacientes, analisaram o tratamento secundário (falha ou recorrência após o tratamento primário); três indivíduos apresentaram nova recorrência. O tempo necessário para resolver as lesões variou de imediato, logo após a cirurgia, até 23 meses, com tratamento com esteroides inalados. Conclusão: Não há evidências de alta qualidade que provem a eficácia de qualquer tratamento para granulomas laríngeos resultantes da intubação endotraqueal.

The Effect of Nasal Steroid Spray on Contact Granuloma of Larynx

BACKGROUND AND OBJECTIVES: Laryngeal contact granuloma is benign inflammatory disease induced by excessive mechanical contact of larynx such as endotracheal intubation, voice abuse, laryngeal microsurgery as well as laryngopharygeal reflux. Because it is caused by various risk factors, multiple treatment modalities are required. The purpose of study is to evaluate treatment effect of topical steroid through nasal cavity in contact granuloma. MATERIALS AND METHOD: Fifty-two patients were enrolled in this study with exception of intubation granuloma. Patients were classified with four groups (Proton pump inhibitor (PPI), Nasal steroid spray (SPR), PPI+SPR, Observation) according to treatment modality. RESULTS: Patients who treated with PPI (Odds ratio 2.45, p=0.03) and combination of PPI and SPR (Odds ratio 2.88, p<0.01) had significantly better response than patients who not treated with medical therapy. CONCLUSION: Combination therapy of nasal steroid spray and PPI is effective for contact granuloma of larynx and considered as a treatment of choice rather than PPI only treatment.

Granuloma laríngeo posintubación: una rara complicación de la intubación traqueal en pediatría. Caso clínico / Post-intubation laryngeal granuloma: a rare complication of tracheal intubation in pediatrics. Case report

Los granulomas laríngeos son lesiones benignas localizadas en el tercio posterior de la glotis, sobre todo, a nivel de la apófisis vocal del cartílago aritenoides. Típicamente, se asocian a tres factores etiológicos: intubación endotraqueal, uso inapropiado de la voz y/o reflujo gastroesofágico. La formación de un granuloma laríngeo posintubación es una complicación tardía relacionada con la lesión por la intubación. Es poco frecuente en el niño, en especial, si el período de intubación es corto. Generalmente, es unilateral y produce disfonía, sensación de cuerpo extraño faríngeo y tos. El tratamiento consiste en la escisión quirúrgica cuando la lesión es pediculada o causa compromiso respiratorio. Se presenta a una adolescente de 14 años que desarrolló un granuloma laríngeo pediculado después de una intubación orotraqueal de menos de 24 horas, el cual se hizo evidente 3 meses después de una cirugía cardíaca. Se describe la patogenia, las manifestaciones clínicas, el diagnóstico y el tratamiento de esta patología.

Laryngeal granulomas are benign lesions located in the posterior third of the glottis, mainly at the level of the vocal apophysis of the arytenoid cartilage. They are typically associated with three etiological factors: endotracheal intubation, inappropriate voice use and/or gastroesophageal reflux. The formation of a post-intubation laryngeal granuloma is a late complication related to intubation injury. It is uncommon in the child, especially if the period of intubation is short. It is usually unilateral and produces dysphonia, pharyngeal foreign body sensation and cough. Treatment consists of surgical removal when the lesion is pediculated or causes respiratory compromise. We present a 14-year-old girl who developed a pediculated laryngeal granuloma after orotracheal intubation of less than 24 hours, which was evidenced 3 months after cardiac surgery. We describe the pathogenesis, clinical manifestations, diagnosis and treatment of this pathology.

Tuberculosis primaria de laringe simulando un carcinoma laríngeo. Reporte de caso / Primary tuberculosis of larynx simulating a laryngeal carcinoma. Report of case

Fundamento: La tuberculosis laríngea es una enfermedad infrecuente, sobre todo cuando se presenta de forma localizada. Objetivo: Exponer la localización laríngea primaria de la tuberculosis que simuló un carcinoma laríngeo. Caso clínico: Paciente de 40 años de edad, fumador de dos cajetillas de cigarro diarias por más de veinte años. Consultó por disfonía persistente de aumento gradual, odinofagia, tos pertinaz y pérdida de 10 Kg de peso en dos meses. El examen físico general fue normal. Se visualizó la cuerda vocal derecha hemiparética de aspecto tumoral en los dos tercios anteriores. En el estudio analítico se encontraron exámenes patológicos como la prueba de la tuberculina, Velocidad de sedimentación globular (VSG) de 95 mm/1ra hora y lactato deshidrogenasa (LDH) de 860 UI/L, fueron totalmente negativos los exámenes imaginológicos. Resultados: El estudio histológico luego de tomar biopsia, confirmó la existencia de tuberculosis laríngea primaria; no existía evidencia clínica ni imaginológica de afectación de otros órganos. Conclusiones: Se presentó un paciente con síntomas laríngeos y constitucionales. La tuberculosis primaria de laringe es una enfermedad rara, infrecuente de la que existen escasos reportes en la literatura médica internacional; teniendo en cuenta además que la tuberculosis inicialmente afecta el pulmón y luego se disemina.

Background: The laryngeal tuberculosis is an uncommon illness, mainly when it is presented in a located way. Objective: To expose the primary laryngeal localization of the tuberculosis that simulated a laryngeal carcinoma. Clinical case: Patient of 40 years old, smoker of two daily cigarette packs for more than twenty years. He was consulted for persistent dysphonia of gradual increase, odynophagia, tenacious cough and loss of 10 Kg of weight in two months. The general physical exam was normal. The right hemiparetic vocal cord of tumor aspect was visualized in the two previous thirds. In the analytic study, pathological exams were found as the tuberculin test, Speed of globular sedimentation (VSG) of 95 mm/1st hour and lactate dehydrogenase (LDH) of 860 UI/L, the x- ray exams were completely negative. Results: The histological study after taking biopsy, confirmed the existence of primary laryngeal tuberculosis; there was no clinical or imagiologic evidence of involvement of other organs. Conclusions: A patient was presented with laryngeal and constitutional symptoms. The primary tuberculosis of larynx is a strange illness, uncommon of which there are scarce reports in the international medical literature; also keeping in mind that the tuberculosis initially affects the lung and then it is disseminated.

A Case of Co-Existence Squamous Cell Carcinoma with Granuloma in Posterior Glottis / 대한이비인후과학회지

The laryngeal granuloma (LG) is non-neoplastic lesion that mainly develops in the posterior vocal folds. It is welknown that mis- or overuse of voice, habitual coughing, and endotracheal intubation can become the cause of LG. The laryngopharyngeal reflux also comes into the spotlight as an etiologic factor. Although LG has a tendency to recur easily, it is not a premalignant lesion. The co-existence with granuloma and laryngeal cancer has not been reported earlier. Recently, we encountered a 72-year-old man with a posterior glottic mass, which was diagnosed as squamous cell carcinoma coexisting with granuloma. To our knowledge, this is a first report on two coexisting carcinomas in the glottis.

The clinical analysis and treatment of contact granuloma of larynx / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical features and treatments of contact granuloma of larynx.@*METHOD@#To find the best treatments by analyzing the clinical features, related causes and the treatments of the 13 contact granuloma of larynx cases, which have complete data, of our department from Jan 2005 to Dec 2012, also by comparing the effect of conservative treatment and operation treatment.@*RESULT@#Contact granuloma of larynx is more common in men (84.6%). The main causes are gastro esophageal reflux, chronic cough, habitual hawk and endotracheal intubation disease. However, a big part (38.4%) gets the disease without any other disease history. The main clinical feature of the disease includes: sensation of foreign matter in throat, easy to get exhausted when talking and voice hoarse, but also 30.7% without any feature in throat. Among the 13 cases, 6 were treated by operation and the first recurrence was 66.6%. The cure rate was 50% after one or two operations. The other 7 were treated in conservative way, including anti- Gastro esophageal reflux, avoiding excessive talking, reducing habitual hawk ,or without any medical treatment. The cure rate was 57.1%. The total cure rate was 53.8%. However, it is nonsense to comparing the two different treatments (Chi2 = 0.066, P > 0.05).@*CONCLUSION@#There is still no standard treatment for contact granuloma of larynx and the effect is not good enough. The treatment should be depending on individual case. Conservative treatment is the first choice. However, operation should be considered if the patient has obviously hoarse and his granuloma is too large to breathe well.

Incidentally detected laryngeal granuloma during orotracheal intubation under direct laryngoscope: A case report

Intubation granuloma is a delayed complication of endotracheal intubation in adults.The most frequent complaint of the patient with laryngeal granuloma is hoarseness and the most common location of the granuloma is the vocal process of arytenoid cartilage.We report a female patient with incidentally detected granuloma during endotracheal intubation who had no preoperative vocal symptoms.

Aspectos clínicos, histológicos e de microscopia eletrônica dos granulomas de intubação das pregas vocais / Clinical, histological and electron microscopic aspects of vocal fold granulomas

Granulomas são lesões bilaterais e pediculadas das apófises vocais. Etiologias: intubação, refluxo, traumatismos, fonotraumatismo e idiopática. OBJETIVO: Analisar aspectos clínicos e morfológicos dos granulomas de intubação. MATERIAL E MÉTODOS: Estudo retrospectivo dos pacientes submetidos à microcirurgia por granulomas de intubação, atendidos na Instituição onde foi realizado, a partir de 2002. Analisaram-se: idade, sexo, indicação e tempo da intubação, sintomas, laudos de videolaringoscopia e número de biópsia. Realizou-se estudo histológico em todos os casos e de microscopia eletrônica em três deles. RESULTADOS: 10 pacientes (7 F e 3 M), idade entre 2 anos e 72 anos e tempo de intubação entre 4 horas e 21 dias. Rouquidão foi o principal sintoma. A histologia mostrou hiperplasia epitelial, intenso inflamação importante no corion e proliferação vascular. Na MEV observou-se epitélio escamoso com escassa descamação. À MET, junções intercelulares alargadas e desmossomos alterados. No corion havia lagos sanguíneos, intensa inflamação, e fibroblastos com alterações estruturais como núcleos irregulares e cisternas dilatadas. CONCLUSÕES: Granulomas pós-intubação aparecem em qualquer idade, mesmo em intubação por curto período, e causam rouquidão precocemente. As principais alterações morfológicas são observadas no corion, como proliferação vascular, inflamação e alterações estruturais em fibroblastos indicando disfunção e dano celular.

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.

A Case of Laryngeal Granuloma Successfully Treated with Kairosan / 日本東洋医学雑誌

Laryngeal granulomas which grow in the rear of the vocal cords can be a refractory and recurrent condition, because of various pathogeneses and a lack of established treatment guidelines. We experienced a laryngeal granuloma case which recurred repeatedly, and was resistant to modern medicinal treatment. The laryngeal granuloma recurred after microlaryngosurgery. And though a second microlaryngosurgery and laser cauterization was done, followed by prescription of lansoprazole, tranilast, chlarithromycin and inhalation of fluticasone propionate, the laryngeal granuloma recurred once more. Thus, we tried Kampo medicines at the this time. Hangekobokuto, saishakurikkunshito and keikyososooushimbuto were stopped due to lack of efficacy on the ganuloma, and the Kampo formulation was changed to kairosan. Three weeks after changing formulation, the granuloma was no longer seen with laryngeal fiberscopy. And to-date, recurrence of the granuloma has not been confirmed. This case suggests that fatigue, body weight loss, bilateral Kyokyo-kuman (discomfort of the hypochondrium), bilateral excessive strain of abdominal muscles, pulsation of both the upper and lower navel, and tympanitic sound in upper abdomen may be clinical indications for kairosan.

A clinical and pathological analysis on laryngeal contact granuloma among 18 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize the clinicopathologic feature and diagnostic and therapeutic experience of laryngeal contact granuloma.@*METHOD@#A retrospective study was carried out among 18 cases with this disease through careful analysis on their clinical and pathological data.@*RESULT@#All of 18 cases were male, aged 34 to 78 years,The most common symptoms were hoarseness. In general the granuloma located on the posterior of the larynx unilaterally. The histological appearances of the lesions were typical inflammatory granuloma. Little allotype cell were found in one histologic sample. Fifteen cases received surgical excision and the recurrence rate was 60% after operation. Recidivist received operation again,4 cases among these cases received antireflux therapy after operation but 3 cases recurrences again. Among those follow-up cases(3 cases), 1 case was self-cure and other 2 cases appeared no marked change during observation period.@*CONCLUSION@#Laryngeal contact granuloma predilected the middle-aged male. The localization and appearance of the granuloma is very characteristic. The correct diagnosis can be established by clinical examination alone, but the histological examination is necessary in order to avoid missed diagnosis. There is a high recurrence rate after operation and the effect of antireflux therapy need further research.

Treatment of laryngeal granuloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study treatment method of laryngeal nonspecific granuloma.@*METHOD@#Twenty-five patients with histopathologically identified laryngeal nonspecific granuloma were retrospective reviewed from 1998-2005. All patients were surgically treated by laser laryngomicrosurgery under general anesthesia, postoperative non-operative therapies included anti-gastroesophageal reflux medication, topical inhalant steroid (Beclometasone, Fluticasone) and voice therapy. Two patients were treated with 12 Gy of low-dose radiotherapy after surgery.@*RESULT@#Laryngeal nonspecific granuloma have remarkable tendency of recurrence despite of surgery and non-surgical managements. Recurrence of laryngeal nonspecific granuloma occurs between 2-3 months postoperatively and requires repeated operation for 3 5 times. For intubation granuloma, 6 out of 8 were healed. Six out of eight contact granulomas were healed. Six of gastroesophageal reflux granulomas were healed. Glottic carcinoma was demonstrated in one case after 2 sessions of combined managements. Two patients were completely healed by low-dose radiotherapy of 12 Gy.@*CONCLUSION@#Laryngeal nonspecific granuloma have an obvious tendency of recurrence, however, surgery is an important therapy. Combined non-surgical therapies (anti-gastroesophageal reflux medication, topical inhalant steroid and voice therapy) are necessary. In case which routine ways fail to control recurrence, low-dose radiotherapy is recommended because of its safety and satisfied effect.

Granuloma de processo vocal: caracterização clínica, tratamento e evolução / Vocal process granuloma: clinical characterization, treatment and evolution

O granuloma de processo vocal é uma doença cuja etiopatogenia não é bem definida. Assim, o tratamento clínico e cirúrgico não é padronizado e os resultados terapêuticos variam de acordo com o serviço. OBJETIVO: Objetivando caracterizar os pacientes com granuloma de processo vocal tratados em nosso serviço, a abordagem terapêutica utilizada e a evolução clínica. MATERIAL E MÉTODO: realizamos um estudo retrospectivo pela análise de seus prontuários. Encontramos maior incidência de granuloma de processo vocal em homens, exceto em casos associados à intubação laríngea. RESULTADO: O fator etiopatogênico associado mais freqüente foi o refluxo laringo-faríngeo (RLF), seguido de intubação laríngea e abuso vocal. O tratamento clínico com inibidor de bomba de prótons (IBP), corticosteróide tópico e fonoterapia foi suficiente para remissão da lesão em 48,6 por cento dos casos. A cirurgia para remoção do granuloma associada ao tratamento clínico foi eficaz em cerca de 90 por cento dos casos. Recidivas tardias (após um ano) foram observadas em cinco pacientes, sugerindo que o controle dos fatores etiopatogênicos associados deve ser mantido por tempo prolongado.

Granuloma laringeo: tratamento fonoterápico / Laryngeal granuloma: voice therapy

Os autores relatam o caso de uma paciente de 37 anos de idade com granuloma cirúrgico. Submeteu-se à fonoterapia após recusa do tratamento cirúrgico obtendo completa remissão da lesão

Preliminary Results of Mitomycin-C Application in the Treatment of Laryngeal Stenosis and Granuloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mitomycin-C is an antibiotic, antineoplastic agent that inhibits DNA and protein synthesis, and fibroblast proliferation. It has been successfully used in adjunction to glaucoma surgery, dacryocystorhinostomy, pterygium surgery, and middle meatal antrostomy. The purpose of this study is to evaluate the efficacy and safety of intraoperative Mitomycin-C application as an adjunct therapy in the endoscopic treatment of laryngeal stenosis and granulation. MATERIALS AND METHOD: A total 13 subjects, of whom 2 had anterior glottic web, 4 posterior laryngeal stenosis, and 7 laryngeal granuloma were included. All underwent stroboscopy and were treated with endoscopic laryngomicrosurgery with CO2 laser. Then, 1 cc of 0.4 mg/mL Mitomycin-C was directly applied for 4 minutes on the surgical site. The patients' symptoms were assessed, and the size of the airway was graded on a scale of I (< or =50%) to IV (total occlusion) after a mean follow-up period of 5 months. The recurrence of the laryngeal granuloma was checked. RESULTS: There was a significant improvement in postoperative symptoms in the group of posterior laryngeal stenosis. Two with tracheotomy underwent decannulation. The postoperative size of airway was markedly increased and restenosis was not noted. There was only one case of recurrence in the granuloma group. CONCLUSION: According to these preliminary results, it is suggested that application of Mitomycin-C can be used as a beneficial adjunct therapy in the endoscopic COc laser excision for laryngeal stenosis and granuloma.

Granuloma laríngeo: un enfoque multi-etiológico / Laryngeal granuloma: a multi-etiological focus

Granuloma, úlcera o paquidermia de contacto, son términos usados para referirse a una lesión inflamatoría crónica localizada en el tercio posterior de la cuerda vocal, especialmente en la zona de la apófisis vocal del aritenoides. Se ha descrito como sus causas: uso inadecuado y abuso de la voz, intubación endotraqueal y reflujo gastroesofático (RGE). Los síntomas más frecuentes son: disfonía, sensación de cuerpo extraño, tos, carraspera y antecedentes de infecciones de vía aérea superior. El tratamiento de estas lesiones se realiza según su etiología: si es por RGE, es médico; en caso de existir abuso vocal, es fonoaudiológico. El tratamiento quirúrgico se indica en granulomas de gran tamaño que reducen el lumen de la vía aérea, en aquellos post intubación que no ceden espontáneamente, y para realizar diagnóstico diferencial mediante biopsia. En este estudio se analizaron 14 casos, de los cuales 5 correspondieron a mujeres y 9 a hombres. Respecto a la etiología, 3 fueron causados por abuso vocal, 3 por RGE, 2 posterior a intubación y en 6 pacientes, ésta fue mixta: RGE asociado a abuso vocal. El tratamiento realizado en 7 pacientes fue médico quirúrgico, por presentar granulomas de gran tamaño o post intubación. En los 7 restantes se efectúo sólo tratamiento médico, con remisión total de la lesión

Granuloma posterior da laringe: evoluçäo após injeçäo de botox / Laryngeal posterior granuloma: follow-up afer botox injection

O granuloma posterior da laringe ocorre geralmente na região aritenóidea, na maioria da vezes sobre o processo vocal, sendo relacionado a três fatores predisponentes: o abuso vocal, a doença do refluxo gastroesofágico (GERD)e a intubação orotraqueal. Consideramo-lo de causa idiopática quando não há evidência de nenhum desses fatores. A remoção cirúrgica resulta em frequentes recidivas, exceto nos casos pós-intubação. O tratamento direcionado aos fatores desencadeantes mostra resultados animadores, mas nem sempre a regressão ocorre. Recentemente, a injeção de toxina botulínica (Botox) na prega vocal tem sido utilitada como recurso alternativo, com bons resultados, quando os demais tratamentos foram ineficazes. Nosso objetivo é fazer o relato de um caso de granuloma posterior da laringe e de seu seguimento, mostrando sua regressão após a injeção de Botox no músculo tireoaritenóideo

Lesöes crônicas da laringe pela intubaçäo traqueal / Chronic larynx lesions by tracheal intubation

INTRODUÇÄO: Várias complicaçöes, muitas vezes graves, têm sido relacionadas com a intubaçäo traqueal (IT), com incidência chegando a 18 por cento. OBJETIVO: Analisar as alteraçöes da laringe provocadas pela IT: o desenvolvimento de estenose e de granuloma na laringe e a evoluçäo da voz. PACIENTE E MÉTODOS: Foram estudados prospectivamente 73 pacientes internados na Unidade de Terapia Intensiva do Hospital Cajuru, fa Pontifícia Universidade Católica do Paraná, na regiäo Sul do Brasil, submetidos a IT por cinco dias consecutivos e com previsäo de necessidade de IT por mais sete dias, que foram traqueostomizados no sexto dia de IT. Foi realizada fibrolaringotraqueobroncoscopia (FLTB) nos 6§, 14§, 21§, 28§, 60§, 90§ e 180§ dias após a IT. RESULTADOS: No 180§ dia do estudo havia 30 pacientes sobreviventes: 18 apresentavam vos normal, nove näo puderam ser avaliados e três apresentavam disfonia. Em oito pacientes foram observados granulomas na laringe, sendo que cinco foram curados espontaneamente, dois foram ressecados e um permaneceu no 180§ dia do estudo. Apenas um paciente apresentou estenose de laringe. CONCLUSÄO: Devido ao menor tempo de exposiçäo da laringe ao trauma da cânula orotraqueal, a realizaçäo da traqueostomia no 6§ dia da IT parece causar poucas complicaçöes

Granuloma Laríngeo / Vocal process granuloma

O granuloma laríngeo é uma afecçao rara cuja patogênese é pouco compreendida, consistindo de acúmulo de tecido sobre o processo vocal da aritenóide, relacionado a alguma forma de trauma na regiao posterior da laringe: abuso vocal, refluxo gastroesofágico, intubaçao endotraqueal, após injeçao de Teflon ou após cirurgias da laringe com remoçao de excesso de tecido. Embora a aparência seja semelhante, a evoluçao clínica e o tratamento sao diferentes conforme a causa. Nosso propósito é discutir sobre sua etiologia, diagnóstico e tratamento.