Botulinum toxin for vocal fold granuloma: a systematic review and meta-analysis of treatment outcomes and recurrence

To synthesize outcomes after botulinum toxin A (BTX-A) injection for vocal process granuloma (VPG), including remission, recurrence, time to resolution, and safety.

We pooled 18 studies (n = 1,146 patients; 298 received BTX‑A) reporting clinical outcomes after BTX‑A injection for VPG. Random‑effects meta‑analysis produced pooled event rates with 95% confidence intervals; prespecified subgroup analyses compared primary versus refractory contact granulomas (CG) and intubation‑related granulomas (IG).

Overall pooled complete remission after BTX‑A was 87.6% (95% CI 82.6-92.9%); most remissions occurred within 1-3 months. Subgroup pooled complete remission rates were 87.4% (95% CI 81.3-93.9%) for refractory CG, 91.1% (95% CI 79.8-103.9%) for primary CG, and 70.2% (95% CI 57.1-107.2%) for intubation‑related granulomas. Overall pooled Recurrence after initial remission was 6.9% (95% CI 3.1-15.5%); subgroup recurrence estimates were 9.4% for refractory CG, 5.7% for primary CG, and 19.8% for refractory IG. Pooled adverse‑event rates included hoarseness 9.1%, aspiration/choking 29.1%, and breathiness/dysphagia 29.4%; most events resolved within weeks to a few months. Objective voice‑quality measures were infrequently reported.

BTX‑A injection achieves high short-term remission and low Recurrence in VPG, with mostly transient side effects. It shows good durability in contact granulomas but less so in intubation-related lesions. More randomized studies with validated voice outcomes are needed to determine optimal dosing and long-term effectiveness.