We retrospectively reviewed 27 patients with laryngeal granulomas who were surgically treated at the Kurume University Hospital between November 1990 and January 2011. There were 17 men and 10 women whose ages ranged from 23 to 75 years (median : 52.5 years). The chief symptoms were hoarseness in 20 cases (74.1%), dyspnea in 9 (33.3%), pharynx incongruity in 4 (14.8%) and cough in 1 (3.7%). Causes of the disease were intubation in 13 cases (48.1%), voice abuse in 3 (11.1%), gastro-esophageal reflux disease in 2 (7.4%), cough and injury in one, respectively. While the posterior glottis was the most frequent site of granuloma development, as found in 20 cases (74.1%), there were a few cases of development in the membranous potions of the anterior commissure and subglottis. With regard to the size of the granulomas, 10 to 14mm was the most frequent occurrence, thereby indicating surgery.
Post operative recurrence was observed in 12 cases (44.4%), but they recovered by conservative treatment in most cases. In the analysis of recurrence according to the cause of granulomas, a “temporary stimulus” such as intubation and injury revealed lower rate than cases where granuloma were caused by a “repetitive stimulus” such as vocal abuse, reflux of stomach acid and cough (p=0.05).
Excision with cold instrument (knife or scissors) had a lower rate of recurrence than excision with CO2 laser. Steroid injection into the wound after excision showed a lower rate of recurrence in granulomas by temporary stimulus, and showed a significantly lower rate than CO2 laser vaporization to the wound (p=0.01).
