title: Vocal process granulomas: a systematic review of treatment.
abstract: OBJECTIVE
  Vocal process granulomas (VPGs) are benign laryngeal lesions with controversial treatment and a tendency to recur. There are several treatment options with unpredictable results, high recurrence rates, and disappointing long-term outcome. The aims of this article are to focus on evidence-based current treatment strategies for primary lesions and recurrences.
  
  
  METHODS
  The data came from a systematic review of the literature.
  
  
  METHODS
  Main outcome measures were recurrence rate, reduction, and/or complete resolution. Inclusion criteria included English literature, randomized and nonrandomized trials, prospective and retrospective studies, and primary and recurrent cases. Exclusion criteria included case reports, teaching reviews, and papers not focusing on treatment.
  
  
  RESULTS
  The time frame of the included studies was from 1997 to 2012. There are 6 different treatment options (single or combined) for VPG. Antireflux medication is the mainstay treatment and when combined with lifestyle changes and voice therapy results in the lowest recurrence rate. "Bloodless" in-office or in-theater laser techniques appear to have lower recurrence rates when compared to traditional cold steel microlaryngoscopy techniques, especially for recurrences.
  
  
  CONCLUSIONS
  There is level 2A evidence that antireflux treatment is the main treatment strategy for vocal process granulomas with surgery reserved only for failures of medical treatment or airway obstruction or when diagnosis is in doubt.
authors.affiliation: Department of Otolaryngology, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Petros D
authors.initials: PD
authors.lastname: Karkos
authors.forename: Michael
authors.initials: M
authors.lastname: George
authors.forename: Jan
authors.initials: J
authors.lastname: Van Der Veen
authors.forename: Helen
authors.initials: H
authors.lastname: Atkinson
authors.forename: Raghav C
authors.initials: RC
authors.lastname: Dwivedi
authors.forename: Dae
authors.initials: D
authors.lastname: Kim
authors.forename: Costa
authors.initials: C
authors.lastname: Repanos
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D006099:Granuloma; D006102:Granuloma, Laryngeal / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008019:Life Style; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D013070:Speech Therapy; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D014827:Vocal Cords
chemical_list: D013256:Steroids; D001905:Botulinum Toxins
keywords: antireflux treatment; benign; gastroesophageal reflux; larynx; laser; lesions; proton pump inhibitors; recurrence; resolution; speech therapy; vocal process granulomas