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Diagnosis
Physical Characteristics
Contact granulomas can be physically identified and diagnosed by observing the presence of proliferative tissue originating from the vocal process of the arytenoid cartilage.[1] Identification is carried out by laryngoscopy, which produces an image of the lesion in the form of an abnormal growth (nodule or polyp) or ulceration.[1][2] The vocal process is overwhelmingly the most common laryngeal site for these lesions, although they have also been observed on the medial and anterior portions of the vocal folds.[2] In nodule or polyp form, contact granulomas generally have a grey or dark red colouring[1][2] and measure 2 to 15 mm in size.[1] Contact granulomas can occur unilaterally or bilaterally, affecting one or both vocal folds.[1][2]
Treatment
Steroids
The application of corticosteroids to treat contact granulomas is considered a more extreme approach[2] and its utility remains in contention.[1][2] When employed, it is usually used in conjunction with antibiotics for the reduction of pain and inflammation related to the granuloma.[1] This treatment can be administered orally, through inhalation, or through intralesion injection.[1]
Botox Injection
The injection of botulinum neurotoxin A, or Botox, to treat contact granulomas is considered a more extreme approach[2], and is generally only pursued when the case has been resistant to other treatments.[1][3] In this approach, Botox is injected into the thyroarytenoid muscle (unilaterally or bilaterally), targeting a reduction in the contact forces of the arytenoids.[1]
Epidemiology
Across all posited aetiologies, contact granulomas are more commonly observed in male patients than in female patients, and more commonly in adult patients than in pediatric patients.[2] In cases where gastroesophageal reflux disease is identified as the most likely cause of the granuloma, the patient is most commonly an adult man in his 30s or 40s.[2] When contact granulomas do occur in female and pediatric patients, they usually occur post-intubation.[2] There are no observable age or gender trends within the category of post-intubation patients suffering from contact granulomas, nor within the causation category of vocal abuse history.[2]
- ^ a b c d e f g h i j Hoffman, Henry T.; Overholt, Edwin; Karnell, Michael; McCulloch, Tim M. (2001-12-01). "Vocal process granuloma". Head & Neck. 23 (12): 1061–1074. doi:10.1002/hed.10014. ISSN 1097-0347.
- ^ a b c d e f g h i j k Devaney, Kenneth O.; Rinaldo, Alessandra; Ferlito, Alfio. "Vocal process granuloma of the larynx—recognition, differential diagnosis and treatment". Oral Oncology. 41 (7): 666–669. doi:10.1016/j.oraloncology.2004.11.002.
- ^ Karkos, Petros D.; George, Michael; Veen, Jan Van Der; Atkinson, Helen; Dwivedi, Raghav C.; Kim, Dae; Repanos, Costa (2014-03-17). "Vocal Process Granulomas". Annals of Otology, Rhinology & Laryngology. 123 (5): 314–320. doi:10.1177/0003489414525921.