Management of Laryngeal Contact Granuloma

Ko, Moon-Hee; Son, Young-Ik; Jang, Jeon-Yeob; So, Yoon-Kyoung; Chung, Man-Ki

J Korean Soc Laryngol Phoniatr Logop > Volume 19(2); 2008 > Article

Journal of The Korean Society of Laryngology, Phoniatrics and Logopedics 2008;19(2): 128-132.

후두 접촉성 육아종의 치료

고문희, 손영익, 장전엽, 소윤경, 정만기

성균관대학교 의과대학 삼성서울병원 이비인후과학교실

Management of Laryngeal Contact Granuloma

Moon-Hee Ko, Young-Ik Son, Jeon-Yeob Jang, Yoon-Kyoung So, Man-Ki Chung

Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine

ABSTRACT

Background: Laryngeal contact granuloma is an inflammatory hypertrophic granulation tissue arising at around the vocal process of arytenoid cartilage. Various approaches are currently used for the treatment, but a solid guideline has not been established. Objectives:
We aimed to compare the each treatment modality in the hope of suggesting a guideline for the successful management of laryngeal contact granuloma. Method: Eighty-seven treatment cases of 56 patients were analyzed. Cases having recent intubation history were excluded from the study. All patients received vocal hygiene education. Proton pump inhibitors (PPI, N = 33) or H2 receptor antagonists ($H_{2}RA$, N =26) were used as a first-line treatment. Among the non-responders to $H_{2}RA$, 11 cases received PPI as a second-line therapy. Eight cases received botulinum toxin injection and 9 cases had laryngomicrosurgical removal.
Results:
As an initial therapy, response rate to PPI and $H_{2}RA$ was 60.6% and 38.5% respectively, which was not statistically different (p=0.091). Response rate of PPI as the second-line therapy was 36.3% (p=0.162 when compared to that of first-line PPI therapy). Response rate of Botulinum toxin injection was 75%. All cases of surgical removal recurred in a relatively short period (mean 1.9months).
Conclusion:
In patients having laryngeal contact granuloma, combined therapy with vocal hygiene education and PPI medication would provide more than 60% of therapeutic response. Botulinum toxin injection is highly effective even in non-responders to antireflux therapy. The only indications of surgery are to resolve diagnostic doubt or to treat acute airway compromise.

KEY WORDS： Laryngeal granuloma;Treatment outcome;Gastroesophageal reflux;

중심 단어： 후두 육아종;치료;위식도 역류질환;