Contact Granuloma Research Articles

Analysis of the efficacy of vocal cord botulinum toxin injection for refractory laryngeal contact granuloma

Objective: To observe the efficacy of vocal cord botulinum toxin type A injection in the treatment of refractory laryngeal contact granuloma and to analyze the factors affecting the curative effect. Methods: Fifty-two patients with refractory laryngeal contact granuloma who received vocal cord botulinum toxin type A injection under topical anesthesia from May 2021 to May 2023 were analyzed retrospectively. Among them, 51 were males and 1 was female, aged 22-66 (48.98±8.87)years old. All patients were followed up for a minimum of 12 months. Outcome measures in terms of patient cure rate, total effective rate, complications and recurrence rate were calculated. The median [M (Q1, Q3)] was used to represent non-normally distributed measurement data, and Logistic regression analysis was used to determine independent risk factors affecting efficacy. Results: The cure rate of 52 patients with refractory laryngeal contact granuloma treated by vocal cord botulinum toxin type A injection was 78.8% (41/52), and the total effective rate (including cure, marked and effective) was 90.4% (47/52). The median number of injections was 1[1,2]. Following a single injection, the cure rate was 69.2% (36/52), and the median treatment duration for cured patients was 3 [3,3] months. Hoarseness occurred in 88.5% (46/52) of patients, with recovery within 3 months in all cases. Additionally, 21.2% (11/52) of the patients experienced cough, sore throat, dyspnea, all of whom recovered within 3 months. One patient among the 41 cured cases was lost to follow-up, and the recurrence rate at the 12th month was 17.5% (7/40). Multivariate regression analysis indicated that age, granuloma size, history of PPI treatment, previous corticosteroid injections, prior surgical excision, pharyngeal reflux, chronic cough, pharyngeal reflux, chronic cough and vocal overuse were not independent risk factors for cure and recurrence. Conclusion: Vocal cord botulinum toxin type A injection is an alternative for the treatment of refractory laryngeal contact granuloma, which offers benefits such ashigh cure rate, short treatment cycle and less injection times.

Granulation tissue-like spindle cell (sarcomatoid) carcinoma of the head and neck: a deceptively bland-looking underdiagnosed malignancy

The diagnosis of head and neck spindle cell squamous carcinoma (SC-SCC) is often challenging. Lesions with a prominent inflammatory infiltrate and reactive vessels may have a granulation tissue-like appearance, therefore being difficult to distinguish from reactive lesions, like contact ulcers, post-intubation granulomas, inflammatory pseudotumors, or benign vascular lesions. In this study, we analyzed the clinicopathological features of a series of 17 head and neck SC-SCC with granulation tissue-like appearance. All patients, but two, were males, ranging in age between 57 and 80 years. The larynx was the most frequently affected site (n = 12), followed by the tongue (n = 4). One tumor was hypopharyngeal. Most consult cases were submitted with benign suggestion or because of unexpected recurrences of granulation tissue polyps. Histologically, all lesions consisted of an ulcerated polypoid proliferation of moderately to markedly atypical spindle cells, with a minor component of conventional invasive or in situ squamous carcinoma. At least one cytokeratin cocktail was positive in 13 cases. The staining was limited to a few neoplastic cells in most cases. Positivity for p63, p40, and cytokeratins 5/6 was detected only in the conventional squamous cell carcinoma component, when present. ALK1 was negative in all cases. Sixteen cases were tested for p53 and all showed aberrant expression (12 diffusely positive and 4 of null-phenotype). The diagnosis of granulation tissue-like SC-SCC is challenging due to the close clinical and histological overlap with several benign conditions. Since the expression of epithelial markers is limited, the use of an immunohistochemical panel including p53 is recommended.

The effectiveness of various treatment approaches for laryngeal contact granulomas.

To assess and compare the effectiveness of various treatment approaches for laryngeal contact granulomas (LCG). A retrospective analysis was conducted on a cohort of 45 patients diagnosed with LCG at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to May 2023. Based on the treatment modalities administered, patients were categorized into three groups: acid suppression alone, hormone injection combined with acid suppression, and surgery combined with acid suppression. Subsequently, the study compared differences in treatment efficacy and average healing time among these three groups, using various indicators. The findings indicate that the granuloma size in LCG patients with hoarseness (0.126, 95% CI 0.087-0.288) was significantly greater compared to LCG patients without hoarseness (0.047, 95% CI 0.014-0.083) (P = 0.001). However, there were no significant variations in age, morphology (unlobulated/lobulated), laterality ratio (left/right), sex ratio (male/female), history of tracheal intubation (non-intubation/intubation), and RFS score (RFS > 7/RFS ≤ 7) (P > 0.05), regardless of the presence of hoarseness symptoms. At the treatment observation endpoint of 3months, the curative ratio in the group receiving hormone injection combined with acid suppression was found to be significantly higher compared to the group receiving acid suppression alone (P = 0.018). In addition, the average healing time of patients in the hormone injection combined with acid suppression group was notably shorter than that of the acid suppression alone group (P = 0.007). The combination of hormonal injections and acid suppression may enhance the curative ratio and expedite the healing time of LCG.

Prevalence of Benign Vocal Fold Lesions: Long-Term Results From a Single European Institution

Hoarseness and limited voice capacity are often associated with benign vocal fold (VF) lesions. Despite their high clinical prevalence, epidemiological investigations focusing on these structural alterations are rare. The aim of the study was to present current European data on five typical lesion types (VF nodules, polyp, cyst, contact granuloma, Reinke´s edema). Retrospective investigation. Video recordings of laryngoscopies from all patients with one of the above-mentioned VF pathologies were subjected to a review process. Data collected arose from a single institution over a period of 13years. They were evaluated statistically with respect to lesion type, sex, age at first diagnosis, and affected side. In a total of 535 patients, VF polyps occurred most frequently, followed by Reinke's edema and nodules. Each of the lesion types studied was significantly associated with sex and, except VF cysts, all diagnoses were also significantly related to age. Female sex was a risk factor for VF nodules, cysts, and Reinke's edema, whereas male sex was associated with polyps and contact granulomas. VF nodules occurred predominantly in young patients, VF polyps in middle-aged, Reinke's edema, and contact granulomas in later adulthood. The predominantly affected side (bilateral, right, or left VF) depended on sex. Different prevalences from previous studies resulted from inconsistencies in terms of classification framework, terminology, and definition. In addition to endoscopic findings, socio-cultural backgrounds must also be considered when studying benign VF lesions. Prophylactic voice care education for all populations and concomitant efficacy studies are required. Further research is needed to verify possible correlations between sex and the affected side. A non-binary view could broaden the spectrum of phoniatric research issues.

History of Previous Surgical Resection Promotes the Sclerosis of the Arytenoid Cartilage in Patients With Laryngeal Contact Granuloma

To explore the relationship between arytenoid cartilage sclerosis and a history of previous surgical resection in patients with laryngeal contact granuloma. 167 patients with laryngeal contact granuloma treated from March 2016 to December 2018 were studied. The high-resolution computed tomography (HRCT) data of the sclerosis of arytenoid cartilage is divided into asymmetric sclerosis, bilateral sclerosis, and no sclerosis according to the range of sclerosis. The proportions of various ranges of sclerosis in two subgroups of patients were compared to patients with and without a history of previous surgical resection. The arytenoid cartilage sclerosis rate of 167 patients was 69.46%. The exact probability method showed that P<0.001, suggesting that the distribution of arytenoid cartilage sclerosis was different in patients with and without a history of previous surgical resection, and there was a moderate correlation between the extent of arytenoid sclerosis and history of previous surgical resection (Cramer's V=0.436, P<0.001). There were 18 cases of bilateral sclerosis in patients with a history of previous surgical resection, of which 50% had contralateral recurrence after combined therapy (proton pump inhibitor (PPI) and glucocorticoid injection into granuloma via the thyrohyoid membrane approach), accounting for 75% of recurrence after combined therapy. Surgery promotes the expansion of arytenoid sclerosis, Patients with bilateral arytenoid sclerosis are prone to recurrence of contralateral laryngeal contact granuloma.

Treatment Results of Vocal Process Granuloma: Intubation versus Contact Granuloma

Introduction Contact granulomas (CGs) and intubation granulomas (IGs) are known to have different clinical manifestations despite having the same pathological features. Objective The purpose of the present study was to analyze the treatment results for CG and IG and to obtain clinical information. Methods We retrospectively reviewed the medical records of patients diagnosed with vocal process granuloma (VPG) between January 2015 and December 2018. The patient's age, sex, medical history, lesion size, lesion type, reflux finding score (RFS), response to treatment, duration of treatment, and follow-up period were compared. Results Eighteen patients with CG and 14 patients with IG were included in the study. The IG group had more female patients ( p = 0.0009), showed better response to proton pump inhibitor (PPI) and steroid inhalation (SI) ( p = 0.036), and had a shorter treatment period ( p = 0.0029) than the CG group. Five patients who received botulinum toxin injections in their vocal cords had complete remission. Conclusion Compared with CG, IG was more responsive to treatment with PPI and SI and required a shorter duration of treatment.

Laryngeal contact granuloma after radiotherapy in patients with nasopharyngeal carcinoma: a case series.

Laryngeal contact granuloma (LCG) is a benign hypertrophic lesion and phonatory injury after abnormal vocal behavior is regarded as its major etiology. Patients receiving radiation for non-laryngeal head and neck tumors are troubled by persistent voice impairment. The occurrence of LCG after radiotherapy for nasopharyngeal carcinoma (NPC) in our practice has implored us to re-exam their underlying etiology. We hypothesize that a proportion of LCG results from voice change caused by non-laryngeal head and neck cancer radiotherapy and firstly describe a distinct LCG population originated after radiotherapy for NPC with respect to the clinical profile, presentation, prognosis and response to treatment of patients. We retrospectively reviewed the laryngoscopic examination and tumor study findings to elucidate the common clinical features of patients who presented with LCG after radiotherapy for NPC. All patients were regularly monitored with telescopic examination until lesions disappeared. Data on age, sex, clinical presentation, telescopic findings, management, latency time of lesion formation, remission time and clinical outcome were reviewed. The medical review identified 27 cases of LCG secondary to radiotherapy for NPC. All lesions had been diagnosed during routine endoscopy following radiation. The interval between radiation onset and endoscopic diagnosis was 3.77 months (range, 0.67-11 months). 20 cases were resolved through simple observation, 4 cases were resolved with the administration of proton pump inhibitors (PPIs), and 3 cases with a poor response to PPI therapy required subsequent surgical resection. The mean remission time in the observation and PPI groups was 4.42 months (range, 0.73-18.9 months) and 5.78 months (range, 2.17-14.63 months), respectively. All patients recovered completely and none experienced recurrence during a mean follow-up of 32.44 months (range, 5.6-71.67 months). Iatrogenic granulomas of vocal process are presenting after radiation for non-laryngeal head and neck cancers. In contrast with spontaneous granulomas, these granulomas can be cured at high remission rates and low recurrence trend without specific intervention. Thus, simple observation may be sufficient for radiation-induced LCG.

Comparison of the Effects of Botulinum Toxin A Injection and Local Glucocorticoid Injection for Treating Laryngeal Contact Granuloma

To compare the effects of botulinum toxin A injection and local glucocorticoid injection for treating laryngeal contact granuloma and to discuss the indications for both regimens. The case data of 50 patients with laryngeal contact granuloma in the outpatient clinic of the Sixth Medical Center of the PLA General Hospital from January 2020 to December 2021 were reviewed, and the patients were divided into the following two groups according to the different treatments received: botulinum toxin A injection or local glucocorticoid injection. Quantitative assessment of the lesion size was performed using Image J software to compare the efficacy in the two groups. On comparing the cure rate between the two groups at 3 months after treatment, 72% of patients in the botulinum toxin A group were cured compared to 40% of patients in the glucocorticoid group (P=0.023). On comparing the cure rate between the two groups at 6 months after treatment, 88% of patients in the botulinum toxin A group were cured compared to 64% of patients in the glucocorticoid group (P=0.047). Botulinum toxin A injection is superior to local glucocorticoid injection, and local glucocorticoid injection is more appropriate for patients who cannot tolerate the adverse effects of botulinum toxin A.

Prognosis of patients with laryngeal contact granuloma: Development and validation of RCGSG score.

This study aimed to develop an objective and simple score for predicting the prognosis of patients with laryngeal contact granuloma (LCG) treated with local glucocorticoid injection combined with oral proton pump inhibitor (GI + PPI). Cox regression analysis was used to analyze the effect of baseline variables on the prognosis of 507 patients with LCG treated with GI + PPI. An easy-to-apply RCGSG (Reflus, Cough, Gender, and Surgery in GI + PPI therapy) score was developed based on the independent risk factors selected by univariate and multivariate Cox regression analyses. The score was internally validated by receiver-operating characteristic curve, calibration curve, and decision curve analysis. After univariate and multivariate analyses, male gender (hazard ratio [HR] 0.546, p < .001), laryngopharyngeal reflux (HR 0.702, p=.001), chronic cough (HR 0.709, p=.001), and history of surgical resection (HR 0.433, p < .001) were found to be the independent risk factors affecting the prognosis of LCG. According to the score, the median cure time was 3 months (95% confidence interval [CI] 2.81-3.19) in the low-risk group, 4 months (95% CI 3.74-4.26) in the moderate-risk group, and 5 months (95% CI 4.76-5.24) in the high-risk group. The bootstrap method was used to plot calibration curves for internal validation. The RCGSG score, developed based on laryngopharyngeal reflux, chronic cough, gender, and surgical resection history, has been internally verified to be a good predictor of the prognosis of patients with LCG receiving GI + PPI treatment. Level 4.

Thyroarytenoid botulinum toxin injection for refractory laryngeal contact granuloma

BackgroundAlthough there are many treatments for laryngeal contact granuloma (LCG), some patients still fail treatment. Botulinum toxin A injection vocal cords may be a salvage therapy. ObjectivesTo study the efficacy of thyroarytenoid botulinum toxin A injection for the treatment of refractory LCG. Material and methodsFrom May 2021 to March 2022, 23 male patients with refractory idiopathic LCG were treated by injection of botulinum toxin A into the thyroarytenoid muscle via the thyrohyoid membrane approach. Inspiratory-phase laryngoscopy images were collected before treatment and 3 months after injection treatment. The lesion size was evaluated with the Farwell granuloma endoscopic grading system and Image J software. ResultsThe average age of 23 patients was 49 years. The dose of botulinum toxin injection ranged from 2.5 to 5 units. Three months after injection, 17 patients were cured, 2 patients showed marked improvement, and 4 patients did not experience any effect. The total efficacy rate was 82.61% (19/23), and no serious complications occurred. Almost all patients experienced hoarseness within one week after injection; they gradually recovered after one month, and their voice returned to baseline at 3 months. ConclusionsThyroarytenoid botulinum toxin injection is an effective method for resolving refractory LCG.

Clinical Evaluation of Intraoral Suture Patterns Using Poliglecaprone 25 in Greyhound Dogs.

To evaluate healing and complications of extraction sites closed with a simple interrupted pattern (SI) and a simple continuous (SC) suture pattern in a prospective randomized clinical trial. Greyhounds were selected from a rescue with a standardized environment and naturally occurring disease. Surgical extractions were performed (35 sites) and all mucogingival flaps were closed with 4-0 poliglecaprone 25 using either SI or SC randomly assigned by surgical site. Oral healing/dehiscence, suture inflammation, suture loss, accumulation of debris, presence/nature of discharge, necrotic tissue and adjacent contact ulceration were evaluated. Fisher's exact test was used to compare categorical data and two-tail T tests used to compare continuous data. Results showed SC was faster to apply. No new dehiscence events were detected after Recheck 1. There was no significant difference for dehiscence scores between SI and SC. A trend was seen towards more major dehiscence in the SI group. This study concluded SC is an alternative to SI for closure of occlusal surfaces in the mouth. Mandibular canine tooth extraction sites were more likely to have a high dehiscence score than all other sites combined regardless of surgical technique.

Detection of Vocal Cord Ulcer Using Advanced 3D ST Volumetric Segmentation Net Architecture

Vocal Cord Ulcer (VCU) is a contact ulcer that decreases the musculoskeletal laryngeal tension when speaking. With the advanced technology, including high-decision cameras and computational energy, it appears to be easy to construct. However, identifying laryngeal variation caused by VCU in CT images is still problematic. The paper aims to use image processing techniques to quantify the laryngeal variation caused by VCU, determine, and analyze its severity. The proposed 3D Swin Transforms Volumetric Segmentation Network (STVSNet) reduces the entanglement and improves the segmentation accuracy. Volumetric quantification on Contrast-Enhanced computed tomography (CECT) uses 3D STVSNet to extract shapes feature to evaluate the VCU severity. Evaluation results were 96.20% sensitivity, 97.15% accuracy, and 96.16% specificity. Concomitantly compared different prevail methods show better results for quantitative data. Experimental results show that 3D STVSNet indicates precise segmentation results for detecting VCU in any image type.

The effect of surgical resection on the treatment of idiopathic laryngeal contact granuloma

Objective:The aim of this study is to investigate the effect of surgical resection of idiopathic laryngeal contact granuloma on the follow-up treatment. Methods:From April 2014 to December 2019, the clinical data of 390 male patients with idiopathic laryngeal granuloma treated were analyzed retrospectively. The patients were divided into the group with history of surgical resection （172 patients） and the group without surgical resection history （218 patients）, and then both received the combined therapy. The treatment efficacy of the two groups were compared. Results:By the end of 6 months after beginning the combined therapy, the total efficacy rate of the patients with a history of surgery was 71.5%（123/172）, and that in patients without a history of surgery was 97.7% （213/218）. The difference between the two groups was statistically significant（Z=-7.828, P=0.0001）. Among the cured patients, the cure time of patients without the surgery history was shorter than patients with surgery history（Z=-4.441, P=0.0001）. Conclusion:Surgical treatment of laryngeal contact granuloma increases the difficulty of follow-up treatment, so surgical treatment is not recommended for newly diagnosed patients with laryngeal contact granuloma.

Efficacy of the Accent Method of Voice Therapy in Professional Voice Users with Minimal Associated Pathological Lesions of the Vocal Folds.

Minimal associated pathological lesions (MAPLs) of the vocal folds are a group of benign disorders commonly related to phonotraumatic conditions and behaviors. Voice therapy (VT) can play a major role in readjusting these maladaptive behaviors and improve overall voice quality, thereby replace surgical intervention in some cases or act as a complementary treatment to enhance the ultimate therapeutic outcomes. This study aims to explore the short-term effect of the Accent method of VT on vocal subjective measures and acoustics in professional users with MAPLs, evaluate the responsiveness of each vocal fold lesion to the VT, and propose a simple model for providing VT to a sector of the population in great need of non-invasive management. This analytical cross-sectional included fifty professional voice users with different MAPLs were exposed to multidimensional voice assessments before and after receiving VT training in a tertiary care hospital. These assessments include GRBAS score, Multidimensional Voice Program (MDVP) and validated Arabic version Voice Handicap Index (VHI-30). This study showed variable positive effects of VT on the different types of MAPLs. Cysts had the highest level of responsiveness to VT in comparison to other lesions, followed by nodules, polyps, contact granuloma, and Reinke's edema. VT is a substantial solution for managing voice disorders. It should be considered in the management plan of the various types of MAPLs, even in Reinke's edema, which showed the minimum improvement.

Treatment Results of Vocal Process Granuloma: Intubation Versus Contact Granuloma

Background and Objectives Vocal process granulomas (VPGs) are benign lesions of the larynx, typically contact granulomas (CG) and intubation granulomas (IG). The two diseases are known to have different clinical manifestations despite having the same pathological features. The purpose of this study was to analyze the treatment results for CG and IG and to obtain clinical information.Materials and Method We retrospectively reviewed the medical records of patients diagnosed with VPG between January 2015 and December 2018. The patient’s age, sex, medical history, lesion size, lesion type, reflux finding score, response to treatment, duration of treatment, and follow-up period were compared.Results In total, 32 patients were included in the study, of which 18 were CG and 14 were IG. In the CG group, males were dominant (n=15, 83.3%), whereas in the IG group, females were dominant (n=11, 78.6%) (p=0.0009). The response to medical treatment using proton pump inhibitor and steroid inhaler was better in the IG group (11/14, 78.6%) than in the CG group (7/18, 38.9%) (p=0.036). Of the 14 patients who did not respond to medical treatment, 5 received botulium toxin injections, and all 5 had complete remission. The duration of medical treatment was significantly longer in the IG group (p=0.0029).Conclusion IG was more common in female, and CG was more dominant in male. IG had better response to medical treatment using proton pump inhibitor and steroid inhaler than CG.

Results of the study of conservative treatment of laryngeal manifestations of laryngopharyngeal reflux

Gastroesophageal reflux disease (GERD) is a disease of the gastrointestinal tract caused by the discharge of stomach contents into the esophagus. In GERD, both esophageal and extraesophageal manifestations are widespread, but, unfortunately, the latter are less well known. About one third of GERD patients have extraesophageal symptoms, which can occur even in the absence of the usual esophageal symptoms of GERD, which makes diagnosis difficult. The most common of these is laryngitis. In addition to reflux laryngitis, laryngopharyngeal reflux (LFR) can cause the development of contact granulomas, laryngeal stenosis, functional dysphonia, vocal fold nodules, Reinecke's edema, and laryngeal neoplasms. These symptoms disappear after taking antireflux therapy, but there is still no consensus on its duration.Aim. To evaluate the results of treatment of laryngeal manifestations of LFR with omeprasole 20 mg 30 minutes before meals in the morning.Methods. The study involved 531 patients with complaints of hoarseness, of which women 337 - 63.5%, men 194 - 36.5%. We prescribed omeprasole 20 mg 30 minutes before meals in the morning for 6 weeks. Patients were questioned using the Reflux Symptom Index (RSI) questionnaire and indirect laryngoscopy with an assessment of laryngeal changes according to the Reflux Signs Scale (RSS).Results. There was a statistically significant decrease in hoarseness 1 week after treatment, which continues to decrease 6 weeks after the initiation of treatment when evaluating the data on the RSI questionnaire. There was no statistically significant difference in the laryngoscopic picture before the start of treatment and after 1 week of treatment according to RSS; a statistically significant decrease in the quantitative assessment of RSS was revealed 6 weeks after the initiation of treatment.Conclusions. Omeprasole at a dose of 20 mg in 30 minutes reduces the symptoms of LFR already after 1 week, the decrease in the severity of symptoms continues by 6 weeks of its use. Improvement of the laryngoscopic picture with the appointment of omeprazole 20 mg 30 minutes before meals occurs by the 6th week of its use. A positive correlation was found between the severity of LFR symptoms, including hoarseness, and the severity of changes in the laryngoscopic picture.

Noninvasive Detection of Arytenoid Cartilage Calcification Using Computed Tomography and Prediction of Prognosis in Laryngeal Contact Granuloma

Laryngeal contact granuloma (LCG) is a relatively uncommon disease with chronic inflammatory stimulation, and long-term reflux irritation is a vital factor for arytenoid cartilage calcification. Our investigation compared the severity of ipsilateral arytenoid cartilage calcification with the frequency of recurrence of LCG after surgical treatment. A retrospective chart review of prospectively gathered data over five years from 327 patients, including 153 subjects without laryngeal lesions, were age- and sex-matched normal controls, 103 patients with various other vocal cord lesions were in the laryngeal lesion group and 71 LCG patients met the diagnostic criteria pathologically. All subjects underwent laryngeal high-resolution computed tomography (HRCT) prior to therapeutic interventions. The computed tomography (CT) value and arytenoid cartilage calcification were obtained using image data before surgery, and their clinical significance was further analyzed. Seventy-one patients with LCG, including sixty-two males, were enrolled in the study. Among these cases, there were 67 patients with unilateral vocal cord lesions. Of the 103 eligible patients in the laryngeal lesion group, 87 had unilateral lesions, which including eighty-seven men. Of the 153 average subjects, 105 were male. The rate of arytenoid cartilage calcification in the LCG group was dramatically higher in the lesion side than in the laryngeal lesions and normal group (P < 0.01). Furthermore, the CT value (P < 0.01) and range of calcification (P < 0.01) were significantly higher in patients with LCG than in those with laryngeal lesions. Importantly, patients with high CT values and the calcification range of lesions in the arytenoid cartilage displayed a greater lesion size and recurrence rate than patients with low CT values and lesion areas (P < 0.01). Our results suggest that most patients with LCG present with calcification of the arytenoid cartilage. The more severe the calcification in the arytenoid cartilage, the greater the risk of granuloma size and recurrence in LCG after surgical treatment. CT and bone density testing of the arytenoid cartilage may be an essential method to evaluate the prognosis of LCG.

Short-term outcome of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females.

To evaluate the short-term efficacy of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females. A total of 14 female patients with laryngeal contact granuloma treated in our outpatient department from November 2017 to January 2020 were included in the study. Inspiratory-phase laryngoscopy images were collected before treatment and 1month after each injection, and the lesion size was measured and evaluated with ImageJ software. Two patients achieved complete remission after one injection, with a percent reduction of 100%. After two injections, 4 patients achieved complete remission, with a percent reduction ranging from 96% to 100%. After 3 injections, 4 patients achieved complete remission (including one patient with bilateral lesions), and the percent reduction ranged from 95% to 100%. Three patients achieved incomplete remission, with a percent reduction of 46%, 55%, and 81%, respectively. In one case, there was no remission, and the granuloma increased in size after treatment. In women with laryngeal contact granuloma, transcutaneous glucocorticoid injection therapy can quickly resolve the granuloma in a short period.

The Nature and Risk Factors of Minimal Associated Pathological Lesions of Vocal Folds at Two Hospitals in the Gulf Area

To identify the possible risk factors related to etiology of the minimal associated pathological lesions (MAPLs) of the vocal folds and their impacts on the recurrence of lesion. This analytical cross-sectional study included 200 subjects presented with dysphonia to the Phoniatrics/Voice Clinics in two hospitals in Gulf region (KSA and UAE). Same number of matched voluntaires from the same hospitals (hospital staffs, employees and their relatives) and relatives of subjects with typical voice quality were included as well. Both groups underwent a simple questionnaire consists of 15 items related to previously accused risk factors of MAPLs. The bivariant analysis by Fisher's exact test showed that male gender, presence of kids, misuse of voice, alcohol, gastroesophageal reflux diseases and voice handicapping are associated with significant risk to have MAPLs with P values < 0.001 for all except for alcohol (P=0.015). Welch's t test revealed higher smoking index in subject than control groups with significant difference (P < 0.001). In contrast, spices, family shouting and nearby industry were not potent risk factors in our study group. Vocal trauma especially in females and children is a potent risk factor for vocal fold nodules and cysts. The gastroesophageal reflux is a suggested risk factor for Reinke's edema and contact granuloma. Smoking is the risk factor for MAPLs particularly polyp, contact granuloma, and Reinke's edema. Also, alcohol consumption is a possible risk factors for Reinke's edema. Identification of risk factors of the MAPLs is an important step in planning therapy. Risk factors which are highly related to a specific type of MAPLs should be involved in any planned program for protection, voice rehabilitation and/or prevention of recurrence of that lesion.

Factors for Predicting the Therapeutic Efficacy of Laryngeal Contact Granuloma

To explore the factors affecting the therapeutic efficacy of laryngeal contact granuloma. The clinical data of 534 patients with laryngeal contact granuloma treated in our hospital from April 2014 to December 2019 were studied. The multivariable logistic regression was performed to find the risk factors influencing the treatment efficacy. Multivariable logistic regression showed that factors related to therapeutic efficacy were granuloma size (P=0.0006) and gender (P=0.0299) in conservative treatment group; laryngopharyngeal reflux (P=0.0115), cough (P=0.0124), and previous surgical history (P < 0.001) in combined treatment group. The surgical treatment had the worst therapeutic efficacy compared with combined treatment and conservative treatment. In the larger granuloma size subgroup, combined treatment showed better results than conservative treatment. Granuloma size and gender affect the therapeutic efficacy of conservative treatment. Previous surgical history, laryngopharyngeal reflux, and cough affect the therapeutic efficacy of combined treatment. Combined treatment is better than conservative treatment alone and surgical treatment shows the worst efficacy.