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 (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.

Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review

“…From these, 64 were related to VF granuloma, 129 to laryngotracheal stenosis, 100 to laryngeal infections, and 48 to leukoplakia. Among these articles, 31 met our inclusion criteria and were kept for analysis ( Figure 1 ): 8 related to VF granuloma ( Table 1 ), 20-27 4 to laryngeal infections ( Table 1 ), 28-31 5 to leukoplakia ( Table 2 ), 7,32-35 and 10 to laryngotracheal stenosis ( Table 3 ). 36-45 Four additional basic research studies were identified concerning the relationship between reflux and the development of laryngotracheal stenosis.…”

“…In 13 studies, the LPR diagnosis was not confirmed through objective examination, or the diagnosis method was not provided. 7,24-27,29,32,33,37-39,42,45 Among these studies, some authors considered GERD symptoms for the diagnosis without considering LPR-associated complaints. 7,32,39,42,45 The objective approaches used for the reflux diagnosis included x-ray 20 ; gastrointestinal endoscopy findings 20,34 ; single-probe, 20,43 dual-probe, 21-23,28 triple-probe, 36,40 or oropharyngeal 41 pH monitoring; manometry 20 ; and pepsin detection.…”

“…A large number of studies based the LPR diagnosis on LPR- or GERD-associated symptoms and findings. 7,24-27,29,32,37-39,42,45 Considering only GERD symptoms creates a selection bias, as LPR is primarily characterized by ear, nose, and throat symptoms, as opposed to GERD where digestive symptoms are predominant. 1 The lack of consideration of laryngopharyngeal symptoms may indirectly exclude some patients with LPR who do not also have digestive complaints.…”

“…49 LPR has long been suspected as an important chemical etiologic factor for granulomas, although it has been studied in only 8 studies ( Table 1). [20][21][22][23][24][25][26][27] Svensson et al 20 suggested the presence of gastroesophageal reflux disease (GERD) in 82% of patients with VF granuloma or contact ulcers through disparate reflux diagnosis approaches-namely, single-probe pHmetry, manometry, x-ray, and esophagitis (seen on gastrointestinal endoscopy). Ylitalo et al 22 and Leonard and Kendall 23 identified acid pharyngeal reflux episodes in 65% and 87% of patients with VF granuloma, respectively.…”

Laryngeal granuloma occurring after surgery for laryngeal cancer treated by surgical removal and immediate post-operative radiotherapy

“…The pathology of laryngeal granuloma is hyperplasic fibrous tissue, the formation of which is same as benign proliferation of normal tissues, such as skin keloid. [1,17] During Several hours after the surgery, the granulation began to form. The main components of the granulation were the immature fibroblasts, the unstable collagen fibers and the new blood capillaries.…”