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Clinical evolution of laryngeal granulomas: treatment and prognosis
P A de Lima Pontes1, N G De Biase, E C Gadelha
1Department of Otorhinolaryngology and Human Communicative Disorders, Universidade Federal de Sáo Paulo, Escola Paulista de Medicina, Instituto da Laringe, Brazil.
Objective/Hypothesis:
To study the response to treatment by patients with granulomas not related to surgery, considering their respective causes.
Methods:
Retrospective study of larynx granulomas seen at the Instituto da Laringe (Sao Paulo, Brazil) from June 1996, totaling 66 patients, being 20 (30,3%) diagnosed with gastroesophageal reflux syndrome, 22 (33,3%) due to vocal abuse, 15 (22,7%) to postorotracheal intubation, and 9 (13,6%) of idiopathic cause.
Findings:
Of the 66 patients diagnosed, 10 did not start the treatment, with only 56 being analyzed, 6 of whom later abandoned the treatment. The cause-oriented treatment showed 100% control in postintubation granulomas. In the cases of reflux and vocal abuse, the success rates when considering only the cause were 75% and 87.5%, respectively. In the cases of undefined cause, all were subjected to surgical removal with or without clinical or speech-therapy treatment; we attained only a 37.5% success rate in the first trial. Of these, after various unsuccessful rescue treatments, three which were treated with botulinum toxin type A had 100% resolution. The recurrence percentage varied according to the cause, being nonexistent in the postintubation cases, 21.4% in patients with reflux esophagitis, 35.2% in vocal abuse, and 62.5% in those of idiopathic etiology.
Conclusion:
Of the laryngeal granulomas, the best prognoses were given by the postintubation ones, whereas the worst were those of undefined cause. Those ascribed to gastroesophageal reflux and vocal abuse have a high resolution rate, although some cases need rescue procedures.