Topical inhalant steroid (budesonide, Pulmicort® nasal) therapy in intubation granuloma

Abstract

Intubation granuloma of the larynx is an iatrogenic disease which is induced by endotracheal intubation. It has basically been managed by conservative medical treatment with observation. Surgical excision can be considered as a last resort due to the high recurrence rate which subjects the patients to repeated anaesthesia. The purpose of this study is to evaluate the therapeutic effect of topical steroid in intubation granuloma, comparing the results of conservative medical treatment with, or without, surgery (Group I, 14 patients) and inhalant therapy with topical budesonide (Group II, 20 patients).In Group I, complete disappearance of granuloma occurred in six cases within a year (42.8 per cent) with conservative therapy only. Microlaryngeal surgery was performed on the eight cases of persisting granuloma after conservative therapy for a year, resulting in two cases of recurrence. In Group II, the granuloma disappeared completely in 85 per cent within six months and in 95 per cent within 12 months without any remarkable side-effects. We concluded that intubation granuloma of the larynx could be treated with topical inhalant steroid as the first choice of therapy rather than other medical treatment or surgical intervention.

Intralesional steroid injection: an alternative treatment option for vocal process granuloma in ten patients

“…Meanwhile, although botulinum toxin injections can be effective to treat vocal process granuloma in those patients who chronically clear the throats, subjects may experience a breathy voice for 2–5 months after the procedure, which may be impractical for occupational voice users. A previous study had applied inhaled budesonide in treating intubation granuloma, which is associated with potential topical side effects such as opportunistic fungal infection and vocal fold atrophy.…”

Vocal process granuloma

“…41 Other suggestions to diminish the risk of injury include appropriate use of muscle relaxants in intubated patients, the use of direct vision technique for placement of the endotracheal tube, use of nontoxic lubricants and tube material, stabilization of the head and neck to minimize movement of the tube during the operation, and extubation before the laryngeal reflexes have recovered. 62 Observation. Appropriate management of vocal process granuloma does not always require eradication of the lesion.…”

“…Observation 1 year after treatment showed the granulomas disappeared in 85% of those receiving the topical steroid and only 42.8% among those did not. 62 Controversy persists as to the value of antibiotics and steroids. As with other disease processes with multiple causes receiving multiple treatments, it is difficult to determine which intervention is responsible for improvement.…”

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.…”