Treatment of Vocal Cord Granuloma

Abstract

Combined surgical and conservative therapy (voice therapy, treatment of infections, allergy, oesophageal reflux, and psychogenic stress) has been used in the treatment of non-specific vocal cord granuloma. Such tumors have a great tendency to recur. The 41 patients with vocal cord granuloma in our study (4 women, 37 men, mean age 56 years) were treated at our hospital during 1980-1986. Nine patients were healed with conservative treatment, 32 were treated by laryngomicrosurgery under general anesthesia and jet-ventilation. The latter group was divided into three treatment groups; 8 of these patients were treated with cryotherapy, 9 with postoperative steroids (Prednisolone 40 mg/day in decreasing doses) and antibiotics, and 15 only with microsurgery. At some phase in their treatment 41% of the patients were able to participate in voice therapy. The most recurrences were found in the group treated with cryotherapy, 2.7 rec./pat.; 1.8 rec./pat. were found in the group that underwent surgery, and 1.7 rec./pat. among the patients treated with steroid-antibiotics. In all three groups, some patients experienced recurrences. In the cryotherapy group, however, recurrent granulomas were large and required reoperation, while those in patients treated with steroid-antibiotics were small and could be cured using conservative therapy. If granuloma does not disturb the voice, cause respiratory obstruction or demand histopathological diagnosis, surgery is contraindicated. Cryotherapy does not help traditional surgery, while steroid-antibiotics administered postoperatively seem to help the healing process.

Vocal process granuloma

“…21,19 The value of oral steroids (40 mg/d of prednisolone in decreasing doses) coupled with antibiotics was retrospectively studied through analysis of 24 patients treated with surgical excision alone (15 patients) or with surgical excision followed by postoperative steroids and antibiotics (9 patients). 61 The recurrence rate was similar between the surgery-only group (1.8 recurrences per patient) and the group that received antibiotics and steroids (1.7 recurrences per patient). The authors identified benefit from the use of steroids and antibiotics from their observations that the recurrences seen in this group were smaller than those who did not receive this adjuvant treatment.…”

Preservation of Function and Histologic Appearance in the Injured Glottis With Topical Mitomycin‐C

“…Therapies for these lesions in humans in the past have largely concentrated on reflux control and voice use modification. When these techniques do not succeed, surgical therapy has produced mixed results, with recurrence rates as high as 54% 14 . In patients known to be at risk for granulation or granuloma formation, such as those intubated for significant periods of time, or those undergoing lesion removal, application of topical mitomycin‐C to the posterior glottis may prove beneficial for prevention of these adverse sequelae.…”

Laryngeal Contact Granuloma

“…Al‐Dousary 3 reported recurrence in 47% of patients 2 to 4 months after surgery. Because surgery is so frequently ineffective, other treatments have been reported, including voice therapy, cryosurgery, botulinum toxin injection, and even radiotherapy 2,4‐6 …”