RESUMEN
OBJECTIVES: Vocal process granulomas (VPGs) are benign laryngeal lesions that may manifest as ulcerated regions of the vocal fold or nodular polypoid lesions. Gold standard treatments for idiopathic VPG are yet to be established at this time. This study evaluated clinical decision-making and outcomes in the treatment of VPG patients based on experiences of academic laryngologists across the United States. METHODS: A 21-question survey was developed to evaluate each respondent's specific VPG patient population, clinical decision-making in treating VPG, and corresponding treatment outcomes. The survey was distributed to 168 laryngologists at academic institutions across the United States. Data were analyzed through the Qualtrics platform. RESULTS: A total of 106 responses were analyzed, with a completion rate of 63.1%. Etiology of VPG was most commonly attributed to phonotrauma (96.2%) and reflux (71.8%). Primary first-line treatment was most commonly antireflux medications (92%). Other common first line treatments included voice therapy (58.8%) and inhaled steroids (42.5%). With these treatments, the majority of laryngologists report that recurrence is uncommon (68.4%). Dysphonia was cited as the most frequent long-term sequelae at 27.8%. CONCLUSIONS: VPG treatment strategies continue to be controversial across the United States with many treatments described in the literature with variable application in the practice of academic laryngologists today. Based on survey results, antireflux medications and voice therapy may be the most widely used and most effective treatment options. Establishment of gold standard therapy for VPG as well as further research into recurrent or persistent VPG despite antireflux and voice therapy should be explored. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:795-802, 2024.
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Disfonía , Laringe , Voz , Humanos , Granuloma , Pliegues Vocales , Disfonía/complicacionesRESUMEN
OBJECTIVE: This retrospective study was undertaken to assess the outcome of the medical and/or surgical management of patients presenting with clinical features of arytenoid granuloma. METHODS: The records of 53 males and 9 females were reviewed for predisposing factors, types of treatment received and recurrence following the treatment. RESULTS: Most of the patients (48 out of 62, 77.4 per cent) were treated conservatively with medical management and voice therapy, which resulted in complete resolution of arytenoid granuloma in over two-thirds of the patients treated (32 out of 48, 66.6 per cent). Overall, 28 patients (out of 62, 45.1 per cent) required surgery (14 failed medical treatment cases and 14 surgery as first-line treatment cases). Of these, five patients (out of 28, 17.9 per cent) had recurrence, and were managed with revision surgery and concurrent local injection of Botox. CONCLUSION: Anti-reflux medication and voice therapy are effective first-line management options. Pre- and post-surgery adjuvant treatment improves the results of surgery. Local injection of Botox was successful in the treatment of failed surgical cases.
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Toxinas Botulínicas Tipo A , Masculino , Femenino , Humanos , Estudios Retrospectivos , Granuloma/cirugía , Cartílago Aritenoides/cirugíaRESUMEN
OBJECTIVE: Vocal process granuloma (VPG) has a varied treatment success rate and may frustrate patients and physicians due to poor outcomes. There is still a lack of standard protocols to manage VPG. This study aimed to review the efficiency of a standardized low-dose laryngeal electromyographic (LEMG)-guided botulinum toxin A (BTA) injection in intractable vocal granulomas. METHODS: Twenty-four patients with intractable VPG were recruited. All patients underwent percutaneous LEMG-guided BTA injection on the thyroarytenoid-lateral cricoarytenoid muscle complex in an office setting. The injecting dose was standardized to 1 U in 0.1 mL normal saline at a time. We evaluated the treatment effect by measuring the lesion size with serial laryngoscope evaluations. RESULTS: The postinjection follow-up time varied from 3 to 23 months. Twenty-one patients (87.5%) experienced complete regression of the granuloma over 1-7 months (median 3 months). No major adverse effects were noted during the follow-up period. CONCLUSION: For recalcitrant VPG, LEMG-guided low-dose BTA injection has the potential to be a safe, efficient, and effective treatment.
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Toxinas Botulínicas Tipo A , Laringoscopios , Toxinas Botulínicas Tipo A/efectos adversos , Electromiografía , Granuloma/diagnóstico , Granuloma/tratamiento farmacológico , Granuloma/patología , Humanos , Músculos Laríngeos , Pliegues Vocales/patologíaRESUMEN
OBJECTIVES: Pain localized to the thyrohyoid region may be due to neuralgia of the superior laryngeal nerve (SLN), inflammation of the thyrohyoid complex, or a voice disorder. We present outcomes of treatment of paralaryngeal pain and odynophonia with SLN block. STUDY DESIGN: Retrospective Review. METHODS: A retrospective chart review of patients undergoing in-office SLN block for paralaryngeal pain between 2015 and 2018 at two tertiary care centers was conducted. Patient demographics, indications, and response to treatment were analyzed. RESULTS: Thirty-eight patients underwent blockade of the internal branch of the SLN for paralaryngeal pain, with 10 excluded for incomplete medical records. Eighty-two percent (23/28) reported an improvement in their symptoms. Patients underwent an average of 2.5 blocks (SD = 1.88, range 1-8), with 10 patients (36%) undergoing a single procedure. Of the 18 patients who underwent multiple blocks, nine had eventual cessation of symptoms (50%) compared to resolution in 6/10 undergoing a single injection. Eleven patients (39%) noted odynophonia related to vocal effort, and all of these patients had improvement in or resolution of their symptoms and were more likely to improve compared to those without odynophonia (P = .006). Of the four patients who had a vocal process granuloma (VPG) at presentation, three had complete resolution of the lesion at follow-up. CONCLUSION: In-office SLN block is effective in the treatment of paralaryngeal pain. It may be used as an adjunct in the treatment of vocal process granulomas, as well as voice disorders where odynophonia is a prominent symptom. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:401-405, 2022.
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Nervios Laríngeos , Laringe , Bloqueo Nervioso , Manejo del Dolor/métodos , Dolor/etiología , Voz , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A 47-year-old man presented to the otolaryngology service with complaint of 6 months of intermittent globus sensation. He reported constant throat clearing and subjective lowering of his voice. Flexible nasolaryngoscopy revealed a large pedunculated mass originating from the left vocal process of the arytenoid, lying superior to the vocal fold. The patient was treated conservatively with an anti-reflux regiment and speech language therapy for 2 months, however he noted marginal worsening in voice over the proceeding interval with an increasing raspy quality. He underwent suspension microlaryngoscopy with biopsy. Microscopic examination demonstrated mucosal epithelium with surface ulceration and considerable fibrinoid necrosis, a mixed inflammatory infiltrate, and abundant granulation tissue with reactive endothelial cells. The diagnosis of laryngeal contact ulcer was rendered. The patient was treated with KTP (potassium titanyl phosphate) laser ablation and corticosteroid microinjection; he tolerated the procedures well and on follow-up noted reduced cough, improving voice quality and no residual dysphagia.
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Enfermedades de la Laringe/patología , Úlcera/patología , Corticoesteroides/administración & dosificación , Humanos , Inyecciones Intralesiones , Enfermedades de la Laringe/terapia , Láseres de Estado Sólido , Masculino , Persona de Mediana Edad , Úlcera/terapiaRESUMEN
Benign laryngeal lesions are often the result of phonotraumatic forces on the vocal folds and thus classically are treated with a combination of voice therapy and phonomicrosurgical techniques to minimize inadvertent additional trauma. Newer management strategies expand on these techniques with the use of the pKTP laser as well as intralesional injections, both in the operating room and in the awake outpatient setting.
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Enfermedades de la Laringe/terapia , Pliegues Vocales/patología , Calidad de la Voz , Toxinas Botulínicas/administración & dosificación , Quistes/terapia , Granuloma Laríngeo/terapia , Humanos , Inyecciones Intralesiones , Laringoscopía , Terapia por Láser , Pólipos/terapia , Esteroides/administración & dosificación , Pliegues Vocales/cirugíaAsunto(s)
Toxinas Botulínicas , Esomeprazol , Benzamidas , Granuloma , Humanos , Morfolinas , Pliegues VocalesRESUMEN
Objective:Anti-reflux medications or botulinum toxin A injections are the main current therapies for the definite vocal process granuloma. This studies is focusing on comparing the effects of proton pump inhibitors plus prokinetic agents with botulinum toxin A injections on vocal process granuloma. Method:Adult patients in our outpatient department (from December 2014 to June 2016) complaining of trachyphonia and/or abnormal pharyngeal sensations who were found to have contact granulomas (38 cases) were included. Patients were divided into two groups according to the treatment selected by themselves: esomeprazole with mosapride citrate (n=28) or botulinum toxin A injection (n=20). The reflux symptom index and reflux finding score determined by electronic fibrolaryngoscopy were utilized to assess efficacy. Result:There was no statistical difference on age, sex and reflux symptom index and reflux finding score before treatment between the two groups. Total effective rate in the esomeprazole with mosapride citrate group and the botulinum toxin A group were 96.43% and 45.00%, separately. The recorded symptoms after therapy resolved with a statistically significant improvement in the esomeprazole with mosapride citrate group. Conclusion:Combined proton pump inhibitor plus prokinetic drug therapy plays a significant role in the treatment of vocal process granulomas.
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Benzamidas/uso terapéutico , Esomeprazol/uso terapéutico , Fármacos Gastrointestinales/uso terapéutico , Granuloma/tratamiento farmacológico , Morfolinas/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéutico , Pliegues Vocales/patología , Adulto , Reflujo Gastroesofágico , Humanos , Resultado del TratamientoRESUMEN
OBJECTIVE: To present the outcomes of office-based autologous fat injection laryngoplasty for the treatment of vocal process granuloma in conjunction with glottic insufficiency. STUDY DESIGN: Retrospective chart review. METHODS: This study included nine patients with vocal process granuloma in conjunction with glottic insufficiency who received autologous fat injection laryngoplasty. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were examined before and after treatment. RESULTS: Of the nine patients, seven (78%) exhibited complete remission. The other two patients (22%) exhibited a partial response following the injection. In a subgroup of five patients who were refractory to antireflux and voice therapies, the resolution rate was 60%. Phonatory function presented significant improvements in jitter, noise-to-harmonic ratio, maximal phonation time, and asthenia. Videolaryngostroboscopic rating revealed significant improvements in closure phase ratio in the vibratory cycle. CONCLUSIONS: Autologous fat injection laryngoplasty can ameliorate glottic insufficiency and the resulting hyperfunctional behavior of the larynx. This therapy also encourages remission of vocal process granuloma and may represent an alternative treatment strategy.
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Tejido Adiposo/trasplante , Procedimientos Quirúrgicos Ambulatorios/métodos , Granuloma Laríngeo/cirugía , Laringoplastia/métodos , Pliegues Vocales/cirugía , Trastornos de la Voz/cirugía , Acústica , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Atrofia , Femenino , Granuloma Laríngeo/complicaciones , Granuloma Laríngeo/diagnóstico , Granuloma Laríngeo/fisiopatología , Humanos , Inyecciones , Laringoplastia/efectos adversos , Laringoscopía , Masculino , Persona de Mediana Edad , Fonación , Recuperación de la Función , Estudios Retrospectivos , Medición de la Producción del Habla , Estroboscopía , Factores de Tiempo , Trasplante Autólogo , Resultado del Tratamiento , Grabación en Video , Pliegues Vocales/patología , Pliegues Vocales/fisiopatología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Calidad de la VozRESUMEN
BACKGROUND: In-office laryngeal surgery is taking on a more commonplace role in the treatment of laryngeal disorders. The potassium-titanyl-phosphate (KTP) laser has been a resourceful adjunct to the management of patients with mucosal lesions of the vocal cords. However, a paucity of data exists for its use in postintubation granulomas treated in-office. CLINICAL CASE: A 43-year-old female presented with voice hoarseness and found to have a large obstructing postintubation granuloma which was treated by in-office KTP laser and en masse excision. CONCLUSIONS: We report the successful case of a patient receiving in-office treatment for a large vocal process granuloma using the KTP laser with en masse excision. The combined use of the KTP laser and forceps in-office can be valuable to the surgical management of vocal process granulomas, given their numerous recurrences. New avenues in office-based surgical management of laryngeal disorders can offer accessibility and decreased morbidity to patients.
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Procedimientos Quirúrgicos Ambulatorios , Granuloma Laríngeo/cirugía , Ronquera/cirugía , Intubación Intratraqueal/efectos adversos , Terapia por Láser/instrumentación , Láseres de Estado Sólido/uso terapéutico , Pliegues Vocales/cirugía , Adulto , Femenino , Granuloma Laríngeo/diagnóstico , Granuloma Laríngeo/etiología , Ronquera/diagnóstico , Ronquera/etiología , Humanos , Laringoscopía , Resultado del Tratamiento , Pliegues Vocales/patologíaRESUMEN
OBJECTIVE: To assess the clinical profile, presentation, prognosis, and response to treatment of patients with posterior glottic lesions and the prevalence of malignancy in this group. STUDY DESIGN: Retrospective cohort. METHODS: Studying medical records, videostroboscopic examinations, and pathologic reports of patients diagnosed and treated between 2008 and 2011. RESULTS: Forty-six patients had lesions limited to the posterior glottis. Forty-one of the cases were diagnosed clinically or pathologically as inflammatory granulation tissue; three were cysts; one carcinoma in situ; and one invasive squamous cell carcinoma. Of the inflammatory granulation patients, 71% had lesions defined as spontaneous and 29% were considered iatrogenic. Reflux symptoms and reflux signs, as well as psychological stress were significantly more prevalent in the spontaneous group. Fifty percent of the patients with spontaneous lesions had psychological stress, compared with 8% in the iatrogenic group (P value = 0.009). Smoking was a significant risk factor in the iatrogenic group (54% vs 21% P value = 0.03). Nine percent of the lesions were treated with primary surgery. Ninety-one percent were treated with primary conservative management, of whom 31% were eventually referred to surgery. Overall, 91% of the patients were treated successfully. All cases of iatrogenic lesions responded to conservative management or a single surgical intervention. All patients that required multiple interventions were spontaneous. CONCLUSIONS: The results of this study suggest that only a small percent of posterior glottic lesions are malignant, thus the decision about biopsy should be based on clinical judgment. Also, spontaneous granulomas are more refractory to treatment, which can be explained by the repetitive exposure to the etiologic factors.