title: Comparison of treatment modalities for contact granuloma: a nationwide multicenter study.
abstract: OBJECTIVE
  This study evaluated the efficacy of commonly used treatment modalities and determined predictors of treatment outcome for contact granuloma.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Twenty otolaryngologists from 18 university hospitals reviewed the medical records of their own contact granuloma patients for the most recent 4 years. To be enrolled as a valid case, each treatment had to continue for at least 3 months. After excluding intubation granuloma, 590 cases of contact granuloma were analyzed. Treatment outcomes were assessed as complete response (CR), marked response (MR), partial response (PR), and no response. The chi-square test was used to compare the efficacy of each treatment modality and logistic regression to determine the predictors of treatment outcome.
  
  
  RESULTS
  The long-term outcomes of good response (GR) (sum of CR and MR) rates after each treatment were 20.5% for observation, 31.6% for steroid inhalation, 44.0% for proton pump inhibitor (PPI), 44.3% for voice therapy, 60.0% for surgical removal, and 74.2% for botulinum toxin injection. Voice therapy, PPI, and botulinum toxin had more good responses than simple observation for the long-term outcome (P < 0.05). Surgical removal had a significantly higher recurrence rate (37.1%) than simple observation (10.3%) (P < 0.05).
  
  
  CONCLUSIONS
  Voice therapy or PPI are recommended as first-line treatments. Surgical removal should be reserved for selected patients because of the high chance of recurrence. Botulinum toxin injection can be used not only for primary cases but also for refractory cases with an expected high response rate.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University, Seoul, Republic of Korea.
authors.forename: Seung Won
authors.initials: SW
authors.lastname: Lee
authors.forename: Hyung Jun
authors.initials: HJ
authors.lastname: Hong
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Sun
authors.forename: Young Hak
authors.initials: YH
authors.lastname: Park
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Lee
authors.forename: Seong Keun
authors.initials: SK
authors.lastname: Kwon
authors.forename: Il Seok
authors.initials: IS
authors.lastname: Park
authors.forename: Sang Hyuk
authors.initials: SH
authors.lastname: Lee
authors.forename: Young-Ik
authors.initials: YI
authors.lastname: Son
mesh_terms: D018450:Disease Progression; D005260:Female; D006099:Granuloma / Q000628:therapy*; D006801:Humans; D007818:Laryngeal Diseases / Q000628:therapy*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Contact granuloma; therapeutic; treatment guideline