This paper will be presented at the 2008 Meeting of the Triological Society.
Does Subepithelial Hemorrhage Cause Persistence of Laryngeal Granuloma?†
Article first published online: 2 JAN 2009
Copyright © 2008 The Triological Society
Volume 118, Issue 5, pages 932–937, May 2008
How to Cite
Yumoto, E., Sanuki, T., Miyamaru, S. and Kumai, Y. (2008), Does Subepithelial Hemorrhage Cause Persistence of Laryngeal Granuloma?. The Laryngoscope, 118: 932–937. doi: 10.1097/MLG.0b013e318163819b
- Issue published online: 2 JAN 2009
- Article first published online: 2 JAN 2009
- Manuscript Accepted: 28 NOV 2007
- Laryngeal granuloma;
- subepithelial hemorrhage;
- hemosiderin accumulation;
- persistence of laryngeal granuloma
Objectives: To determine the incidence of black spots after resolution of laryngeal granuloma (LG), to compare the disease duration from the beginning of treatment to resolution between patients with and without black spots, and to assess the histologic findings of LG in resected or biopsied specimens.
Study Design: Retrospective.
Methods: Forty-six patients with LG on the cartilaginous portion of the vocal fold were included. Their clinical records were reviewed. Histologic specimens were re-examined.
Results: Causes of LG were postintubation in 10 patients, unilateral vocal fold immobility in 1, Candida infection in 1, and were not specified in 34 (either hyperfunctional vocal abuse, laryngopharyngeal regurgitation, or both). Of the 10 patients with postintubation LG, 9 resolved; of the 33 patients with LG from other causes, 21 resolved. Of the 28 resolved patients, 12 developed a black spot at the previous lesion site. Of the 18 patients whose LG resolved without surgical intervention, 11 developed a black spot at the previous lesion site, and the remaining 7 patients did not develop any black spots. The treatment period until LG resolution was significantly longer among patients with a black spot than those without a spot (P = .0372). Histologic examination revealed the presence of hemosiderin accumulation accompanied by infiltration of lymphocytes and macrophages in 8 of the 16 patients who had their LGs resected or biopsied.
Conclusions: Accumulation of hemosiderin in the subepithelial layer, together with little blood flow and dense connective tissue in the cartilaginous portion of the vocal fold, are important factors contributing to the persistence of LG.