Contact granulomas of the larynx

Abstract

Ten cases of intubation granulomas and eight cases of contact granulomas not related to intubation were reviewed for the purpose of clinical analysis and pathological investigation. Granulomas were located primarily at the vocal process of the arytenoid cartilage. Additionally, 58 hemilarynges obtained from 37 cadavers with intubation granulomas were evaluated grossly and histopathologically. The intubation granulomas had no side predilections. All eight contact granulomas occurred in males and had a higher incidence of recurrence (three of eight cases) despite complete removal with laser surgery. In an attempt to explain recurrences of these contact granulomas, all three cases were studied clinically and pathologically. Results indicated that they recurred in singers and vocal abusers, and presumably resulted from the continued hammering of one vocal process against the other. Analysis also demonstrated that vocal rehabilitation was essential prior to or immediately after removal of the granuloma to prevent its recurrence. Pathological evaluation of the contact granulomas revealed focal ulceration and a covering of necrotic tissue with desquamating epithelium. The propria mucosa was edematous and infiltrated by chronic inflammatory cells and neutrophils forming focal granulation tissue in a stroma containing proliferated capillaries. Pathological features around local ulcerations were typical of a secondary granuloma while underlying arytenoid cartilage was partially necrotic.

Fiberoptic Laryngeal Surgery for Vocal Process Granuloma

“…Laser vaporization has been considered to facilitate healing by avoiding trauma to the arytenoid cartilage and removing abnormal tissues after epithelialization is established. 10 However, the recurrence rate did not seem to be affected by the use of laser in our series, and this finding is compatible with the results reported by Benjamin and Croxson.f The pathological process of granuloma has been proven to involve the arytenoid cartilage, as well as the epithelium. Benjamin and Roche'> demonstrated osteosclerosis of the arytenoid cartilage using computed tomography in 21 patients with granulomas.…”

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.…”

Psychological profiles of patients with laryngeal contact granulomas

“…A number of studies have claimed that laryngeal contact granulomas are more prevalent in men and that men become more vulnerable at older ages [1,3,4,6,9,12,15,16,19,21,23,27,28,33]. Psychological or psychiatric consultation of affected patients invariably has revealed hard-driving individuals in a highly competitive environment.…”

“…Recurrence of a contact granuloma may reflect underlying psychodynamic processes that are still active. Because of this, local surgical removal C. Kiese-Himmel · L. Pralle · E. Kruse of a granuloma or vocal therapy will not eliminate existing psychological factors [28]. Wright's early statement [33] that the contact ulcer or granuloma is one of the most unpredictable of the benign lesions of the larynx seems to be still valid.…”