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Assessing the utility of non-surgical treatments in the management of vocal process granulomas

Published online by Cambridge University Press:  10 January 2020

J R Rudman ,
C S McGee ,
J Diaz  and
D E Rosow
J R Rudman
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
C S McGee
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
J Diaz
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
D E Rosow*
Affiliation:
Department of Otolaryngology, University of Miami Miller School of Medicine, Florida, USA
*
Author for correspondence: Dr David E Rosow, Department of Otolaryngology, University of Miami Miller School of Medicine, 5th floor, 1120 NW 14th Street, Miami, FL33136, USA E-mail: [email protected] Fax: +1 305 243 2009
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Abstract

Objective

To determine whether patients would have equivalent or improved outcomes when receiving non-surgical management versus surgical removal for vocal process granulomas.

Methods

A chart review was performed for 53 adults with vocal process granulomas. All patients received baseline anti-reflux treatment consisting of twice-daily proton pump inhibitors and vocal hygiene education. Further treatment approaches were divided into non-surgical (i.e. inhaled corticosteroids, voice therapy, botulinum toxin injections) and surgical groups. Subjective parameters (Voice Handicap Index 10 and Reflux Symptom Index) and outcomes were tabulated and statistically compared. Cause of granuloma was also analysed to determine if this influenced outcomes.

Results

Of 53 patients, 47 (89 per cent) experienced reduction in granuloma size, while 37 (70 per cent) experienced complete resolution. The rate of complete granuloma resolution after initial treatment strategy alone was significantly higher in non-surgical compared to surgical patients (67 and 30 per cent, respectively; p = 0.039). No difference in outcome was seen between iatrogenic and idiopathic granulomas.

Conclusion

Non-surgical patients were more likely to experience initial treatment success than those who underwent surgical removal. Continued emphasis should be placed on conservative treatment options prior to surgery for patients with this condition.

Keywords

Vocal CordsArytenoid CartilageLaryngeal GranulomaTreatment Outcome
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 1 , January 2020 , pp. 68 - 73
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Dr D E Rosow takes responsibility for the integrity of the content of the paper

Presented at the Fall Voice Conference, 12–14 October 2017, Pentagon City, Washington, DC, USA.

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