The new in management of recurrent laryngeal granuloma: long term follow-up

Abstract

Background/Aim: Vocal fold granuloma (VFG) is a nonspecific inflammatory process with no well-defined pathogenesis so its clinical and surgical treatment is not standardized. The aim of the study is to determine accurately the longest permissible period of conservative treatment of recurrent VFG, after which the decision of surgery must be made through long-term follow-up of cases with large recurrent posterior VFG, in addition to assessing the results of anew regimen in management of VFG. Material and Methods: this study conducted on 42patients with large recurrent posterior VFG that were on conservative management as long as the granulomas regress in size with follow-up intervals of 3 months through videolaryngoscope (VLS). Those with resistance VFG were subjected to surgical excision with intra-lesional steroid injection in the pedicle. Results: The most frequent related etiopathogenic factor was gastroesophageal reflux, followed by laryngeal intubation and idiopathic. Clinical management with proton pump inhibitor, systemic or local steroids and voice therapy in addition to behavior modification techniques were enough for remission on 80.95% of the patients. Surgical excision for granulomas was effective in 87.5% of the patients. Early recurrences were noticed in only one patient that proved to have a major gastroesophageal problem. Conclusion: VFG well responds to conservative treatment with complete recovery of maximum period 24months even if it is large and recurrent. Managing recurrent or large posterior VFG needs interdisciplinary team that involves an otolaryngologist, phoniatrician, gastroenterologist, and gastrointestinal surgeon. Voice abuse alone couldn't evoke the condition. Steroids are as important as anti-reflux medication in treatment of VFG.