Operative and Conservative Management of Laryngeal Contact Granuloma: A Network Analysis and Systematic Review

Shu Wei Tsai, Yi Fei Ma, Liang Chun Shih, Yung An Tsou, Chih Kwang Sung

研究成果: Review article同行評審

摘要

Objective: Laryngeal contact granuloma is a disease of benign hypertrophic granulation tissue at the medial side of vocal process. Numerous studies of conservative and surgical management have reported effectiveness, yet optimal treatment has not been standardized. We compared primary and secondary outcomes of conservative and surgical treatment using endoscopic grading, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT), and recurrence rate. Methods: We performed literature searches of MEDLINE, PubMed, and EMBASE from November 1985 to October 2017, with randomized controlled trials and case control studies of at least three months follow-up as the inclusion criteria. Outcomes included laryngoscopic findings, MPT, and VHI-10. Data regarding study design, outcome analysis, follow-up time, and disease remission were systematically collected. Results: A total of 1069 patients were abstracted from 19 papers. With conservative treatment, 98% of patients’ laryngeal granuloma resolved within three months, and 84% for the surgical group. There was a decrease in VHI-10 of 2.69 (95% credible interval (CI) −9.52 to 3.82) and 6.48 (95% CI −15.00 to 1.94) for conservative and surgical management, respectively. MPT improvement was 1.27 s (95% CI: 2.03–5.84) for conservative treatment and 5.02 s (95% CI: 0.78–8.07) for surgical. For all 19 studies, absolute recurrence risk for control, conservative, and surgical measures were respectively 4%, 16%, and 29%. Conclusions: Most patients treated conservatively or surgically alone responded to treatment, but conservative management was favored. VHI-10 and MPT improvement in surgical patients were noted, but only the latter was statistically significant. In regard to recurrence, conservative management had better outcome than surgical. Taken together, the results suggest that minimally symptomatic granulomas have higher response rate and lower recurrence risk when treated conservatively, while larger, symptomatic granulomas may favor surgical excision followed by medical management to reduce risk of recurrence.

原文English
頁(從 - 到)300-306
頁數7
期刊Journal of Voice
35
發行號2
DOIs
出版狀態Published - 2021 三月

All Science Journal Classification (ASJC) codes

  • 耳鼻咽喉科
  • LPN和LVN
  • 言語和聽力

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