Recurrent Contact Granuloma Experience With Excision and Botulinum Toxin Injection

Importance: 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. Design: Case series. The follow-up period had a mean (range) of 41 (11-88) months. Setting: Tertiary referral university clinic. Participants: Twenty patients with recurrent, grade 3 and grade 4 contact granuloma whose lesion was excised at least once after failure of conservative treatments. Interventions: Microlaryngoscopic excision and-botulinum toxin type A injection into the region of the bilateral thyroarytenoid and lateral cricoarytenoid muscles. Main Outcomes and Measures: 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 and Relevance: 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.