A retrospective study of contact granuloma

Ylitalo, Riitta; Lindestad, Per‐Åke

doi:10.1097/00005537-199903000-00017

Cited by 73 publications

(45 citation statements)

References 18 publications

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“…4,7,9,[12][13][14] Studies identifying intubation as a cause of VPG have a majority of female subjects. 5 Males are reportedly more predisposed to age-related changes of the larynx, and this may lead to more secondary hyperfunctional behaviors (muscle tension dysphonia) that exacerbate an already traumatized vocal process. 21 Perhaps, for those patients recalcitrant to medical, behavioral, and surgical treatment, an underlying etiological factor may be glottal insufficiency (e.g., vocal fold atrophy or scar).…”

Section: Discussionmentioning

confidence: 99%

“…These procedures can be performed in the operating room or an in-office setting. 2,[5][6][7][9][10] Previous case series have demonstrated high recurrence rates (as high as 92%) despite surgery and possibly prolonged recovery time. 5 Other forms of treatment have been proposed including antibiotics, corticosteroids, postexcision irradiation, and botulinum toxin A injection.…”

Section: Introductionmentioning

confidence: 99%

“…2,[5][6][7][9][10] Previous case series have demonstrated high recurrence rates (as high as 92%) despite surgery and possibly prolonged recovery time. 5 Other forms of treatment have been proposed including antibiotics, corticosteroids, postexcision irradiation, and botulinum toxin A injection. 2,5,11,[12][13][14] Of these, botulinum toxin A injections have shown the most promise at the expense of a high incidence of symptomatic dysphagia and dysphonia during the treatment period due to the side effects from botulinum toxin A.…”

Section: Introductionmentioning

confidence: 99%

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Vocal process granuloma and glottal insufficiency: An overlooked etiology?

Carroll¹,

Gartner‐Schmidt²,

Statham³

et al. 2009

The Laryngoscope

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Objectives/Hypothesis: Vocal process granuloma has been attributed to intubation, laryngopharyngeal reflux, and phonotraumatic/hyperfunctional vocal behaviors. Vocal process granuloma has recurrence rates following surgical excision approaching 92%. We hypothesize that a portion of persistent or idiopathic cases of vocal process granuloma result from underlying glottal insufficiency (GI) caused by paresis, scar, or atrophy. Our goal was to examine our vocal process granuloma population and determine the incidence of GI, treatment interventions, and outcomes.Study Design: Retrospective chart review. Methods: Thirty-four patients with vocal process granuloma were divided into surgically or conservatively managed groups. Patients were identified if they carried a diagnosis of GI. The time to resolution and number of recurrences within the overall treatment period was recorded and compared between subgroups. Pre-and post-treatment Voice Handicap Index-10 (VHI-10) and Reflux Symptom Index (RSI) scores were compared.Results: Eighteen of 34 patients (53%) carried an underlying diagnosis of GI, 13/34 (38%) were treated surgically, and 8/13 (62%) surgical patients had underlying GI. VHI-10 and RSI scores significantly improved after disease resolution (P < .05).Conclusions: The incidence of GI among patients with vocal process granuloma was 53%. Conservative therapies including treatment of laryngopharyngeal reflux and voice therapy may lead to resolution despite underlying glottal incompetence. If conservative measures fail, recognizing and treating glottal incompetence with true vocal fold augmentation may lead to a shorter surgical treatment course.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vocal process granuloma and glottal insufficiency: An overlooked etiology?

Carroll¹,

Gartner‐Schmidt²,

Statham³

et al. 2009

The Laryngoscope

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show abstract

“…Ylitalo et al in a retrospective study suggested that the trauma of surgery may actually delay recovery. 1 Widely accepted indications for surgical treatment are airway obstruction and the need to establish a histopathologic diagnosis through biopsy. Persistent hoarseness despite appropriate non-surgical therapy is also an accepted indication for surgery.…”

Section: Mechanicalmentioning

confidence: 99%

“…Although there are still proponents for surgical removal in the absence of these indications, the weight of contemporary opinion supports nonsurgical interventions as the primary management. 47,1,23 The recommended extent of surgery needed to remove the granuloma has varied from superficial excision to deeper resection with removal of underlying cartilage. Theoretical support for more aggressive resection is offered by the work of McFerran et al, who, in 1994, examined five patients with vocal process granuloma with CT. 2 They identified increased density of the arytenoid cartilage on the side of a unilateral vocal process granuloma.…”

Section: Mechanicalmentioning

confidence: 99%

Vocal process granuloma

et al. 2001

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Management to diminish laryngopharyngeal reflux, as well as to correct vocally abusive behavior, will appropriately address the majority of vocal process granuloma. Surgical removal is best reserved for cases when conservative management fails, when airway obstruction is a concern, or when a biopsy is needed to establish the diagnosis. Ancillary measures that may be beneficial in specific cases include the use of steroids, antibiotics, membranous vocal fold augmentation, and laryngeal botulinum neurotoxin injection.

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Laryngeal injury from prolonged intubation: A prospective analysis of contributing factors

et al. 2010

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Objectives/Hypothesis The factors leading to laryngeal injury due to intubation are not fully understood. This study sought to determine if duration of intubation, size of endotracheal tube, and/or type of endotracheal tube impact the degree of vocal fold immobility and other laryngeal injury upon extubation. Study Design Prospective study. Methods Sixty-one adult patients intubated for more than 48 hours were examined by recorded flexible nasolaryngoscopy shortly after extubation. Results Forty-one percent of patients had some degree of vocal fold immobility. However, neither the duration of intubation (range, 2–28 days; mean, 9.1 days), the size of endotracheal tube (range, 6 to 8), nor the type of endotracheal tube significantly affected the degree of laryngeal injury including vocal fold immobility. Additionally, none of the collected demographic information (age, gender, height, weight) significantly affected the degree of laryngeal injury. Conclusions In this cohort, duration of intubation, type of endotracheal tube, and size of endotracheal tube do not significantly correlate to the incidence of vocal fold mobility and degree of laryngeal injury noted after prolonged intubation.

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A retrospective study of contact granuloma

Abstract: The recurrence rate after surgery was high. Surgery may prolong the recovery time. Subjective symptoms diminished during voice therapy, but we cannot confirm that it was beneficial for the healing process.

Cited by 73 publications

References 18 publications

Vocal process granuloma and glottal insufficiency: An overlooked etiology?

Vocal process granuloma and glottal insufficiency: An overlooked etiology?

Vocal process granuloma

Laryngeal injury from prolonged intubation: A prospective analysis of contributing factors

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