1
|
Qiang Y, Liu XH, Zhang QQ, Xie M, Guo RX, Shi Y, Yang HN, Cao N, Luo HN. The effectiveness of various treatment approaches for laryngeal contact granulomas. Eur Arch Otorhinolaryngol 2024; 281:1877-1884. [PMID: 38206391 DOI: 10.1007/s00405-023-08436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To assess and compare the effectiveness of various treatment approaches for laryngeal contact granulomas (LCG). METHODS 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. RESULTS 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 3 months, 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). CONCLUSIONS The combination of hormonal injections and acid suppression may enhance the curative ratio and expedite the healing time of LCG. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Yin Qiang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Xiao-Hong Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Qing-Qing Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Meng Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Rui-Xin Guo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Yao Shi
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Hao-Nan Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Nan Cao
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China
| | - Hua-Nan Luo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, No.157 Xi-Wu Road, Xi'an, 710004, Shannxi Province, China.
| |
Collapse
|
2
|
Boyce C, Schmidt KL, Gilbert MR. Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists. Laryngoscope 2024; 134:795-802. [PMID: 37602761 DOI: 10.1002/lary.30976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
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.
Collapse
Affiliation(s)
- Claire Boyce
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kelly L Schmidt
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Mark R Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|