Management of Vocal Process Granuloma: A Systematic Review and Meta-analysis

Vocal process granuloma is a benign laryngeal lesion associated with high recurrence rates, and the optimal management strategy remains uncertain due to heterogeneous treatment approaches and variable outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of available conservative and surgical modalities, either in isolation or in combination, for the treatment of vocal process granulomas. Following PRISMA guidelines, PubMed, Scopus, Web of Science, Cochrane, and EMBASE databases were searched. Retrieved studies were screened according to predefined eligibility criteria, and two authors independently extracted data from the included studies. A total of 49 studies involving 2,818 patients were included, of which 29 studies reported overall response rates. Among these, 5 studies used surgical intervention and demonstrated a pooled rate ratio (RR) of 0.70, whereas 24 studies used conservative treatment and demonstrated a pooled RR of 0.83. In addition, four studies evaluated the use of botulinum toxin combined with proton pump inhibitors (PPI), showing a complete response rate of 0.756. Recurrence rates were assessed in 22 studies, including 14 on conservative treatment and 8 on surgical treatment, with pooled recurrence rates of 0.09 and 0.59, respectively. Three studies using PPIs combined with voice therapy demonstrated a recurrence rate of 0.009. Overall, conservative treatment was associated with improved symptom outcomes and lower recurrence rates compared with surgery alone, although interpretation is limited by heterogeneity and variability in protocols. Combinations of voice therapy with PPIs or botulinum toxin A injections with PPIs were associated with favorable outcomes in several studies. Surgery remains an important option for large or resistant granulomas; however, adjunctive nonsurgical treatment may help reduce recurrence. Further large, randomized trials are needed to minimize selection bias and strengthen the validity of these findings.