title: Does subepithelial hemorrhage cause persistence of laryngeal granuloma?
abstract: OBJECTIVE
  To determine the incidence of black spots after resolution of laryngeal granuloma (LG), to compare the disease duration from the beginning of treatment to resolution between patients with and without black spots, and to assess the histologic findings of LG in resected or biopsied specimens.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Forty-six patients with LG on the cartilaginous portion of the vocal fold were included. Their clinical records were reviewed. Histologic specimens were re-examined.
  
  
  RESULTS
  Causes of LG were postintubation in 10 patients, unilateral vocal fold immobility in 1, Candida infection in 1, and were not specified in 34 (either hyperfunctional vocal abuse, laryngopharyngeal regurgitation, or both). Of the 10 patients with postintubation LG, 9 resolved; of the 33 patients with LG from other causes, 21 resolved. Of the 28 resolved patients, 12 developed a black spot at the previous lesion site. Of the 18 patients whose LG resolved without surgical intervention, 11 developed a black spot at the previous lesion site, and the remaining 7 patients did not develop any black spots. The treatment period until LG resolution was significantly longer among patients with a black spot than those without a spot (P = .0372). Histologic examination revealed the presence of hemosiderin accumulation accompanied by infiltration of lymphocytes and macrophages in 8 of the 16 patients who had their LGs resected or biopsied.
  
  
  CONCLUSIONS
  Accumulation of hemosiderin in the subepithelial layer, together with little blood flow and dense connective tissue in the cartilaginous portion of the vocal fold, are important factors contributing to the persistence of LG.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Honjo, Kumamoto, Japan. yu6167@gpo.kumamoto-u.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Yumoto
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Sanuki
authors.forename: Satoru
authors.initials: S
authors.lastname: Miyamaru
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kumai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002177:Candidiasis / Q000382:microbiology; D004848:Epithelium / Q000378:metabolism / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000209:etiology* / Q000473:pathology*; D006470:Hemorrhage / Q000150:complications*; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D006965:Hyperplasia / Q000378:metabolism / Q000473:pathology; D007818:Laryngeal Diseases / Q000209:etiology* / Q000382:microbiology / Q000473:pathology*; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D014827:Vocal Cords / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*
chemical_list: D006485:Hemosiderin