Surgery and proton pump inhibitors for treatment of vocal process granulomas

Abstract

The aim of this study was to analyze the outcomes of vocal process granulomas treated with surgery and proton pump inhibitors and to specify related factors of recurrence. The medical records of patients with diagnosis of vocal process granuloma between 2000 and 2012 were reviewed. All patients were treated with surgery and proton pump inhibitors for at least 1 month. Forty-one patients were reviewed; mean follow-up time was 45 months. There was no recurrence among the patients who had a recent history of intubation. The recurrence rates of contact granuloma was 38.7 %, and significantly related to the frequency of surgery (P = 0.042), but was not significantly associated with the history of acid reflux (P = 0.676) and vocal abuse (P = 0.447), lesion size (P = 0.203) or surgical techniques (P = 0.331). Surgery combined with proton pump inhibitors was partially effective for the vocal process granulomas, especially with intubated patients. However, repeat surgery for recurrent contact granuloma should be preceded with caution due to high recurrence rates.

Conservative Treatment versus Surgery for Laryngeal Contact Granuloma: A Prospective Study

“…Surgical excision should be performed only if the granuloma does not respond to conservative treatment, needs histological assessment, or causes airway obstruction [4,10] high recurrence rate identified after surgery has also diminished enthusiasm for this intervention in the management of laryngeal contact granuloma [18]. In this series, only 1 patient (2.3%) receiving conservative treatment had recurrent granuloma while approximately 70% of the patients receiving surgery experienced a recurrence.…”

Treatment of Laryngeal Granulomas

“…Among the several treatments, there are proton pump inhibitors, inhaled or oral corticosteroids, nonhormonal anti-inflammatory drugs, and botulinum toxin. 7 8 9 10 Pharmacological treatment is usually slow and requires dietary discipline and changing habits. Surgical treatment is fast, but requires general anesthesia, as well as hospitalization, and is not free of complications.…”

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

“…[10,13] Duan Hong-Gang studied that the repeated operation had no significant effect on recurred patients. [14] The treatment of laryngeal granuloma had to be treated by surgery together with other treatments. Duan Hong-Gang found that combination surgery with proton pump inhibitors (PPIs) can reduce the recurrence from 50% to 38.4%.…”

“…Duan Hong-Gang found that combination surgery with proton pump inhibitors (PPIs) can reduce the recurrence from 50% to 38.4%. [14] Yongli's survey had demonstrated the effectiveness of surgical removal followed by immediate radiation therapy in the management of refractory vocal process granuloma (VPG). In Yongli's study, low-dose RT combined with surgery resulted in a recurrence rate of 0% during the follow-up examinations of the next 3 to 6 years.…”