Laryngeal granulomas associated with superior laryngeal nerve paresis

The association between superior laryngeal nerve (SLN) paresis and laryngeal granuloma formation has not been described earlier. The aim of this study was to present a series of patients with isolated unilateral SLN paresis who developed contralateral vocal process granulomas. The study design was a retrospective chart review including all patients presenting to Indiana University from February 2006 to August 2007 with laryngeal electromyography (LEMG)-documented unilateral SLN paresis and evidence of laryngeal granuloma on videostroboscopy. Patient history, examination, LEMG findings, and response to treatment were recorded. Three cases of unilateral SLN paresis associated with contralateral vocal process granulomas were identified. In all patients, videostroboscopy examination demonstrated shortening of the ipsilateral vocal fold on adduction and asymmetric contact of the vocal processes at the site of granuloma formation. All patients failed to respond to aggressive antireflux therapy. One patient had spontaneous recovery of the SLN paresis, with subsequent resolution of the granuloma. Two patients were successfully treated with surgical laser excision of the granulomas and injection of botulinum toxin into the normal cricothyroid muscle to alter the vocal process contact points. Vocal process granulomas can be associated with unilateral SLN paresis, potentially related to altered contact points between the vocal processes of the arytenoids.