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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2019; 23(03): e322-e324
DOI: 10.1055/s-0039-1688456
Original Research
Thieme Publicações Ltda Rio de Janeiro, Brazil

Treatment of Laryngeal Granulomas

Regina Helena Garcia Martins 
1   Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
,
Norimar Hernandes Dias
1   Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
,
Carlos Segundo Paiva Soares
1   Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
,
Andrea Cristina Joia Gramuglia
1   Botucatu Medical School, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Universidade Estadual Paulista, Botucatu, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

30 August 2018

17 March 2019

Publication Date:
28 May 2019 (online)

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Abstract

Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult.

Objective To describe our experience in the treatment of laryngeal granulomas.

Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment.

Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 µg 12/12 hours (1 month), proton pump inhibitor, omeprazole 40 mg/day (2 months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months.

Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.

Keywords

granuloma - larynx - intubation - treatment