eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Contact Granulomas: Follow-up

Author: James D Garnett, MD, Director of Voice and Swallowing Center, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center
Contributor Information and Disclosures

Updated: Aug 31, 2009

Outcome and Prognosis

  • Eighty to 90% of patients whose major risk factor for contact ulcers is vocal abuse respond to speech therapy and medical management.
  • Seventy to 80% of patients whose major risk factor for granuloma is reflux respond to medical management.
  • Eighty to 100% of patients with postintubation granulomas respond to medical and/or surgical management.
  • Recurrence rate with surgical management is 37-50%.
  • Reports of the use of botulinum toxin type A have shown a 100% success rate, but the numbers in these studies have been small.

Future and Controversies

The emerging role for botulinum toxin type A is overwhelming and may hold promise as a first-line therapy in conjunction with antireflux therapy and speech therapy.

The use of topical anti-inflammatory substances, such as mitomycin-C, may hold promise in operative cases, but more investigation is needed to confirm the efficacy of this therapy.

Use of absolute voice rest in the primary treatment of patients with contact ulcers is controversial. Some individuals believe that voice rest gives the larynx the lack of vocal process contact needed for the ulcer to heal. Others have argued that the goal should be to encourage the patient to speak correctly, using proper voice technique. They believe that modified voice rest under observation of a speech therapist helps the ulcer to heal and allows the patient to acquire those vocal habits that may prevent recurrence.

Others fear that absolute voice rest may cause too great a psychological burden, giving the message that silence is good and speaking is bad. Then, when the person speaks, hyperfunction may be exacerbated because the patient holds back and produces voice with inadequate breath support for fear of injury.

An investigational surgical modality is the use of a flash lamp pulse dye laser fiber, or some other laser that interacts with hemoglobin, through a side port of a flexible laryngoscope in the office setting. In the office, the larynx can be visualized using topical anesthesia, a flexible scope, and a bare laser fiber with a conical spread passed through a side channel to the lesion. The laser would ideally interact with the vascular core of the granuloma, leaving epithelium unaffected. The long-term outcome, overall success rate, and complications of this modality are not yet know, but may offer a viable alternative for granulomata that are poorly responsive to more conservative measures.

 


More on Contact Granulomas

Overview: Contact Granulomas
Workup: Contact Granulomas
Treatment: Contact Granulomas
Follow-up: Contact Granulomas
Multimedia: Contact Granulomas
References
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References

  1. Jackson C. Contact ulcer of the larynx. Ann Otol Rhinol Laryngol. 1928;37:227-30.

  2. Jackson C, Jackson CL. Contact ulcer of the larynx. Arch Otolaryngol. 1935;22:1-15.

  3. Ayazi S, Lipham JC, Hagen JA, Tang AL, Zehetner J, Leers JM, et al. A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold. J Gastrointest Surg. Aug 2009;13(8):1422-9. [Medline].

  4. Bloch CS, Gould WJ, Hirano M. Effect of voice therapy on contact granuloma of the vocal fold. Ann Otol Rhinol Laryngol. Jan-Feb 1981;90(1 Pt 1):48-52. [Medline].

  5. de Lima Pontes PA, De Biase NG, Gadelha EC. Clinical evolution of laryngeal granulomas: treatment and prognosis. Laryngoscope. Feb 1999;109(2 Pt 1):289-94. [Medline].

  6. Gould WJ, Rubin JS, Yanagisawa E. Benign vocal fold pathology through the eyes of the laryngologist. In: Rubin JS, ed. Diagnosis and Treatment of Voice Disorders. New York, NY:. Igaku-Shoin;1995:146-9.

  7. Havas TE, Priestley J, Lowinger DS. A management strategy for vocal process granulomas. Laryngoscope. Feb 1999;109(2 Pt 1):301-6. [Medline].

  8. Nasri S, Sercarz JA, McAlpin T, Berke GS. Treatment of vocal fold granuloma using botulinum toxin type A. Laryngoscope. Jun 1995;105(6):585-8. [Medline].

  9. Orloff LA, Goldman SN. Vocal fold granuloma: successful treatment with botulinum toxin. Otolaryngol Head Neck Surg. Oct 1999;121(4):410-3. [Medline].

  10. Wenig BM, Heffner DK. Contact ulcers of the larynx. A reacquaintance with the pathology of an often underdiagnosed entity. Arch Pathol Lab Med. Aug 1990;114(8):825-8. [Medline].

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Further Reading

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Keywords

contact granulomas, granulomas, contact granuloma, granuloma, vocal cord granuloma, contact pachydermia, pyogenic granuloma, contact ulcer, contact ulcers, vocal process granuloma, larynx

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Contributor Information and Disclosures

Author

James D Garnett, MD, Director of Voice and Swallowing Center, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center
James D Garnett, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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