title: Botulinum toxin: helpful adjunct to early resolution of laryngeal granulomas.
abstract: Treating laryngopharyngeal reflux is the most accepted treatment for laryngeal granulomas. However, response to this treatment is prolonged and in some cases persistent. The authors hypothesize that this is due to the continuous trauma to the mucoperichondrium from adduction of the vocal folds thus preventing regeneration of healthy mucosa. A prospective study was performed on six patients with laryngeal granulomas failing prolonged laryngopharyngeal reflux treatment, speech therapy, and surgical excisions. Botulinum toxin A was injected into the affected thyroarytenoid to reduce adduction trauma. Video-stroboscopy was used to assess response. A 50 per cent reduction in the size of the granulomas was noted within two weeks with a complete and permanent response within two to eight weeks in five out of six patients. One patient had an obstructing pyogenic granuloma that required excision and recurred after excision but responded to a repeated injection. The addition of a single injection of botulinum toxin A to the standard treatment expeditiously eliminated persistent and recurrent laryngeal granulomas.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, Louisiana 71130, USA. cnatha@lsuhsc.edu
authors.forename: Joanne
authors.initials: J
authors.lastname: Pham
authors.forename: Sheng
authors.initials: S
authors.lastname: Yin
authors.forename: M
authors.initials: M
authors.lastname: Morgan
authors.forename: F
authors.initials: F
authors.lastname: Stucker
authors.forename: Cherie-Ann
authors.initials: CO
authors.lastname: Nathan
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006099:Granuloma / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007818:Laryngeal Diseases / Q000188:drug therapy* / Q000601:surgery; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A