Nonoperative Treatment of Laryngeal Granuloma

Abstract

Figure I, initial strobovideolaryn goscopy shows the large bilobed granuloma overlyin g the medial surfa ce of the right arytenoid. Note the erythema of the arytenoids and the posterior cobblestoning despite the pati ent 's use of omeprazole twice daily. Also supp ortin g the diagnosis of persistent reflux laryngitis is the presence ofleft pseudosulcus vocalis (the sulcus ex tends into and beyond the left vocal process).A 60-year-old man with a history of non insulindependent diabetes mellitus, hypertension, and hypothyroidism also had a 6-year history of throat problems, a "gravelly and husky " voice, a loss of singing range at the high end , and vocal fatigue. The vocal dem ands of his occupation (director of dining services at a small college) were extensive; he also sang at his church and lectured at religious conferences. The patient experienced occasion al right-sided throat pain, morning and evening throat soreness, excessive throat clearing, and a bitter taste in the morning. He had been taking omeprazole twice daily for Figur e 2. Strob ovideola ryngoscopy 2 months f ollowing the pati ent 's initial visit sho ws the near-complete resolution of reflux signs and the substantial decrease in the size of the mass.the preceding 2 years, but it resulted in only a slight alleviation of his symptoms.On strobovideolaryngoscopy , the patient was noted to have signs of severe laryngopharyngeal reflux and a large bilobed granuloma overlying the medial surface of the vocal process of the right arytenoid (figure I). A 24-hour pH monitoring test obtained while the patient was taking 20 mg of omeprazole twice daily revealed four episodes of proximal acid exposure. Because the patient had exhibited signs of continuing laryngeal acid expo sure and damage, we increased the dosage of omeprazole to 40 mg Fro m the

Granuloma of the Membranous Vocal Fold: An Unusual Complication of Microlaryngoscopic Surgery

“…2,[6][7][8] Because membranous vocal fold granulomas result from specific, one-time trauma, they appear to be self-limited. It is even possible that they require no treatment, although all patients in this report were Note similarity to initial lesion.…”

“…In cases of vocal process granuloma, removal of the injurious stimuli (eg, pharmacologic therapy for laryngopharyngeal reflux, voice therapy, or botulinum toxin treatment) yields improved tissue appearance with resolution of the granulation tissue. 2,[6][7][8] Because membranous vocal fold granulomas result from specific, one-time trauma, they appear to be self-limited. It is even possible that they require no treatment, although all patients in this report were…”

Laryngeal Granulomas Associated with Superior Laryngeal Nerve Paresis

“…3 When these conservative measures fail, laryngeal surgery (CO 2 laser, pulsed dye laser, cold excision, or cautery) is sometimes effective, and antibiotics, vocal fold augmentation, and laryngeal botulinum toxin injection may also have important roles in treatment. 1,[13][14][15][16] Botulinum toxin has been used to successfully treat vocal process granulomas based on the hyperadduction/hypermobility theory. 17,18 Augmentation of the vocal folds by injection laryngoplasty has also been used successfully in patients with vocal fold paresis and paralysis.…”

A Case Report in Changes in Phonatory Physiology Following Voice Therapy: Application of High-Speed Imaging

“…5 Presenting symptoms from contact granuloma can range from no vocal symptoms; to lump in the throat sensation, pain, and shortness of breath; to severe hoarseness. Owing to the impact stress resulting from repetitive trauma from vocal process contact during phonation, voice therapy is often recommended as a primary mode of treatment 6 coupled with management of laryngopharyngeal reflux. 1,4,[7][8][9] Botox injection and/or surgical excision is occasionally recommended to prevent recurrence.…”