Study On The Causes And Treatment Of Refractory Laryngeal Contact Granuloma

ObjectiveLaryngeal contact granuloma is an inflammatory proliferative lesion with a variety of treatment methods,regardless of which method is chosen,some patients are difficult to treat and are referred to as "refractory laryngeal contact granuloma".This study intends to achieve the following objectives around the causes and treatment of refractory laryngeal contact granuloma:1.To investigate whether the history of surgical treatment is one of the causes of refractory laryngeal contact granuloma;2.To explore the factors affecting the treatment of laryngeal contact granuloma,develop and verify the prediction model;3.To explore the viability of injecting botulinum toxin A for refractory laryngeal contact granuloma;4.To compare the therapeutic efficacy of local glucocorticoid injection and botulinum toxin A injection in refractory laryngeal contact granuloma.Methods1.Review the clinical data of 420 patients with laryngeal contact granuloma who received combined treatment from April 2014 to December 2019,and to investigate whether a history of surgical treatment is one of the causes of refractory laryngeal contact granuloma.2.Review the clinical data of 507 patients with laryngeal contact granuloma treated with combination therapy from April 2014 to February 2022,and to screen the independent risk factors,develop and validate the predictive model.3.Treatment of 23 patients with refractory laryngeal contact granuloma with percutaneous injection of botulinum toxin A into the thyroarytenoid muscle from May 2021 to March 2022,and to evaluate the treatment efficacy.4.Review the clinical data of 47 patients with refractory laryngeal contact granuloma treated with glucocorticoid injections or botulinum toxin A injections from January 2020 to January 2022,and compare their treatment efficacy.Results1.At 6 months after treatment,the total effective rate of combined therapy was 71.5%in the history of surgery group and 97.7%in the no history of surgery group,with a statistically significant difference(Z=-7.828;P=0.0001).The mean time to cure was significantly shorter in the no history of surgery group than in the history of surgery group(Z=-4.441;P=0.0001).2.After multifactorial analysis,male,laryngopharyngeal reflux,chronic cough and history of surgical resection were found to be independent risk factors affecting the prognosis of laryngeal contact granuloma.The regression coefficients of the independent risk factors were combined to assign a score of 1 for laryngopharyngeal reflux,1 for chronic cough,2 for male,and 2 for history of previous surgical resection.Survival curves were plotted for each risk group and the differences among the three groups were statistically significant.Model validated with good discrimination,calibration and net clinical benefit.3.Three months after botulinum toxin A injection,the cure rate was 73.91%and there were no serious complications.Almost all patients experienced hoarseness within one week after injection,they gradually recovered after one month,and their voice returned to baseline at 3 months.4.Compared the cure rate at month 3 after treatment between the two groups,the cure rate in the botulinum toxin A group(74%,17/23)was better than that in the glucocorticoid group(42%,10/24),and the difference between the two groups was statistically significant(χ2=4.148,P=0.042).Conclusions1.The history of surgical resection is one of the causes of refractory laryngeal contact granuloma2.The RCGSG score can be used to predict whether it is the refractory laryngeal contact granuloma or not.The causes of refractory laryngeal contact granuloma includes laryngopharyngeal reflux,cough,gender,and previous surgical resection.3.Thyroarytenoid botulinum toxin injection is an effective method for resolving refractory laryngeal contact granuloma.4.Botulinum toxin A injection is superior to local glucocorticoid injection in treatment of refractory laryngeal contact granuloma,and local glucocorticoid injection is more appropriate for patients who cannot tolerate the hoarseness after botulinum toxin A injection.