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This preliminary report discusses the effects of intralesion local steroid injection for treatment of contact granulomas. Four men between the ages of 39 and 59 years and one woman age 33 years, who were diagnosed with contact granulomas and who failed previous management attempts, are discussed. Intralesion steroid injections of triamcinolone were completed in an otolaryngology outpatient clinic. Results showed that the size of contact granulomas was reduced with injection of the steroid in all five patients. Contact granuloma was completely eliminated in one patient. Furthermore, all patients were clinically asymptomatic 3 to 4 months postinjection, although only two of the five granulo
mas were totally eliminated at the time of longterm follow-up. Clinical improvement was confirmed by direct laryngoscopic evaluation of contact granuloma size 4 months following completion of the steroid injections. A speechlanguage pathologist's knowledge of this technique may prevent patients with granuloma from enduring protracted voice treatment that is historically less effective. The speech-language pathologist's responsibilities include determining patient candidacy for intralesion steroid injection, assisting the otolaryngologist with endoscopic interpretation of the lesion pre- and postintervention, and tracking the clinical outcome of the procedure.
Contact granulomas are considered benign, chronic inflammatory lesions of the laryngeal mucosa. They are typically found along the posterior portion of the vocal fold, concentrated mainly on the vocal process of the arytenoid. They can be either unilateral or bilateral. Frequently cited causes include vocal abuse, endotracheal intubation, and gastroesophageal reflux (Lumpkin, Bishop, & Katz, 1989; Maier, Lohle, & Welte, 1994; Weymuller, 1992). Other factors contributing to contact granulomas include smoking and alcohol abuse, use of a low pitch, and use of an aggressive speaking voice for prolonged periods (Bergamini, Luppi, Dallaeri, Kokash, & Romani, 1995; Colton & Casper, 1996). Each of these abuse factors correlate with irritation of the laryngeal tissue.
Endotracheal intubation causes tissue irritation from the tube pressing against the posterior aspect of the larynx. Injury from the presence of the endotracheal tube may include mucosal erosion in the region of the vocal process of the arytenoid (Weymuller, 1992).
More recently, contact granulomas have been attributed to gastroesophageal reflux (GER). Increased acidity associated with gastroesophageal reflux into the hypopharynx irritates the tissue in the posterior larynx and causes ulceration of the tissue (Lumpkin...