Low-Dose LEMG-Guided Botulinum Toxin Type A Injection for Intractable Vocal Process Granulomas

Area of Science:

• Otolaryngology
• Laryngology
• Neuromodulation

Background:

• Vocal process granuloma (VPG) presents challenges in treatment due to varied success rates and lack of standardized protocols.
• Intractable VPG can lead to patient and physician frustration due to suboptimal outcomes.

Purpose of the Study:

• To evaluate the efficacy of a standardized, low-dose laryngeal electromyographic (LEMG)-guided botulinum toxin A (BTA) injection for managing intractable VPG.

Main Methods:

• Twenty-four patients with intractable VPG received percutaneous LEMG-guided BTA injections into the thyroarytenoid-lateral cricoarytenoid muscle complex.
• A standardized dose of 1 U BTA in 0.1 mL normal saline was administered per session.
• Treatment effectiveness was assessed by measuring lesion size via serial laryngoscope evaluations.

Main Results:

• Complete granuloma regression was observed in 21 out of 24 patients (87.5%) within 1-7 months post-injection (median 3 months).
• Follow-up periods ranged from 3 to 23 months.
• No significant adverse effects were reported during the follow-up duration.

Conclusions:

• LEMG-guided low-dose BTA injection demonstrates significant potential as a safe, efficient, and effective therapeutic option for recalcitrant VPG.
• This approach may offer a standardized and successful management strategy for difficult-to-treat vocal process granulomas.