Surgery and proton pump inhibitors for treatment of vocal process granulomas
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LARYNGOLOGY
Surgery and proton pump inhibitors for treatment of vocal process granulomas Duan Hong-Gang • Jin He-Juan • Zheng Chun-Quan Fan Guo-Kang
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Received: 20 December 2012 / Accepted: 22 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
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. Keywords Laryngeal granuloma Gastroesophageal reflux Proton pump inhibitor Laryngoscopy
D. Hong-Gang Z. Chun-Quan (&) Department of Otolaryngology, Affiliated Eye and Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Fen-yang Road 83, Shanghai, China e-mail: [email protected]; [email protected] J. He-Juan F. Guo-Kang Department of Otolaryngology, 2nd Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Introduction Vocal process granulomas are benign lesions that are most often located over the vocal process of the arytenoids cartilage. Terms used to describe these lesions include laryngeal granuloma, contact granuloma, contact ulcer, and post-intubation granulomas. Causal factors of vocal process granulomas include intubation trauma, gastroesophageal reflux, and vocal abuse. Because of rare incidence (occurring in only about 0.9–2.7 % of adult voice disorders), granuloma mechanisms have not been totally clarified, and the optimal approach to treatment remains controversial [1]. Traditional treatment is generally conservative and includes avoiding known predisposing factors, such as using voice therapy to reduce vocal abuse or proton pump inhibitors (PPIs) to prevent the injury from gastroesophageal reflux [2, 3]. Other treatments for vocal process granulomas include use of steroids, irradiation, and botulinum neurotoxin injections [4–6]. These therapies have demonstrated variable success with long recovery periods. Surgical excision is more controversial than conservative therapy, and a multitude of outcomes result from this type of surgery. The recurrence rate has been reported to be approximately 37.5–50 % [7, 8]. For example, Hirano et al.
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