title: Recurrent contact granuloma: experience with excision and botulinum toxin injection.
abstract: OBJECTIVE
  Contact granuloma is a difficult-to-treat laryngeal disorder associated with vocal abuse, habitual throat clearing, and laryngopharyngeal reflux. It has a high propensity for persistence and recurrence despite many treatment alternatives.
  
  
  OBJECTIVE
  To present our experience with recurrent contact granuloma treated with microlaryngoscopic excision and botulinum toxin injection.
  
  
  METHODS
  Case series. The follow-up period had a mean (range) of 41 (11-88) months.
  
  
  METHODS
  Tertiary referral university clinic.
  
  
  METHODS
  Twenty patients with recurrent, grade 3 and grade 4 contact granuloma whose lesion was excised at least once after failure of conservative treatments.
  
  
  METHODS
  Microlaryngoscopic excision and botulinum toxin type A injection into the region of the bilateral thyroarytenoid and lateral cricoarytenoid muscles.
  
  
  METHODS
  Disappearance of contact granuloma.
  
  
  RESULTS
  Seventeen patients were cured of their contact granuloma. Three patients experienced recurrences: 2 received botulinum toxin injection only as outpatients and recovered. The other patient required reexcision and reinjection under general anesthesia. These 3 patients were free of granuloma at their last follow-up.
  
  
  CONCLUSIONS
  After failed conservative treatment, microlaryngoscopic excision and botulinum toxin type A injection is successful in the treatment of recurrent contact granuloma. Removing recurrent granulomas can result in a low recurrence rate if botulinum toxin type A is added at the time of removal.
authors.affiliation: Department of Otolaryngology, Hacettepe University, Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey. tyilmaz@hacettepe.edu.tr
authors.forename: Taner
authors.initials: T
authors.lastname: Yilmaz
authors.forename: Nilda
authors.initials: N
authors.lastname: Süslü
authors.forename: Gamze
authors.initials: G
authors.lastname: Atay
authors.forename: Serdar
authors.initials: S
authors.lastname: Özer
authors.forename: Riza Önder
authors.initials: RÖ
authors.lastname: Günaydin
authors.forename: Münir Demir
authors.initials: MD
authors.lastname: Bajin
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007818:Laryngeal Diseases / Q000188:drug therapy* / Q000601:surgery*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A