| Objective The mechanism and treatment of laryngeal contact granuloma are often reported,but the results are not consistent with each other.We conduct a series of studies in order to further explore the pathogenic factors and therapeutic methods of the disease,so the purposes of this thesis are:1.To explore the imaging findings of the arytenoid cartilage in patients with laryngeal contact granuloma using the high-resolution computed tomography(HRCT),and compare with the findings in patients with vocal cord carcinoma or vocal cord leukoplakia.2.To study the clinical value of vocal fold injection technique via thyrohyoid membrane(TH)approach.3.To assess and study the efficacy of proton pump inhibitor(PPI)and the intralesional steroid injection combined with PPI in treatment of laryngeal contact granuloma.Methods1.The laryngeal HRCT thin layer scanning images data in 42 patients with laryngeal contact granuloma and 50 patients with vocal cord carcinoma or vocal cord leukoplakia from May 2015 to September 2016 were collected.The sclerosis rates of the arytenoid cartilage in both laryngeal contact granuloma group and laryngeal lesion group were compared.2.The clinical data of 32 patients with laryngeal contact granuloma who treated with intralesional steroid injection via TH approach in our hospital from February 2013 to October 2015 were retrospectively studied.The success rate,tolerance and adverse reactions of the injection were recorded.3.The clinical data of 88 patients with laryngeal contact granuloma who were diagnosed in our hospital from March 2010 to October 2014 were reviewed.Sixty-seven patients only received acid-suppressive therapy as control group,and other 21 patients took intralesional steroid injection combined with acid-suppressive therapy as experimental group.The treatment efficacy and other clinical data of the patients were analyzed.Results1.In 42 patients with laryngeal contact granuloma,the average age was(48.3±9.6)years old.There were 41 patients with unilateral lesion,and one with bilateral lesions.The lesions were located in the left vocal cord process in 28 cases and in the right in 13 cases.In 50 patients in laryngeal lesion group,the average age was(61.2±9.9)years old.There were 39 patients with unilateral lesion and 11 with bilateral lesions.The lesions were located in the left vocal cord in 13 cases and in the right in 26 cases.The rate of arytenoid cartilage sclerosis was 79.07%(34/43)in the lesion side and 7.32%(3/41)in the healthy side in LCG group,and 13.11%(8/61)in the lesion side and 2.56%(1/39)in the healthy side in laryngeal lesion group.The rate of arytenoid cartilage sclerosis in the lesion side of patients with LCG was significantly higher than that in the healthy side of patients with LCG,and also significantly higher than that in both the healthy and lesion sides of patients with laryngeal lesions(P1,2,3=0.001).2.The 34 lesions of 32 patients received vocal fold intralesional steroid injection through TH approach.A total of 113 injections were performed and the median of injections in each patient was 3 times.All of the patients cooperated well with a 100%successful injection rate.No side effects were found during the follow up for a median of 26 months.3.The 67 patients with LCG received only acid suppression therapy,50 patients were cured(74.63%)and the average cure time were(5.31±0.38)months,the total efficacy rate was 97.01%.The 21 patients received intralesional steroid injection combined with acid-suppressive therapy,15 patients were cured(71.43%)and the average cure time were(3.801±0.43)months,the total efficacy rate was 95.24%.The cure rate had no significant differencebetween the two groups,but the cure time in the steroid injection group was shorter.(Z=-2.093,p=0.036).Conclusion1.The sclerosis rates of the arytenoid cartilage of the lesion side in laryngeal contact granuloma group sclerosis was 79.07%.The sclerosis of the arytenoid cartilage was not related to the age of the patients,and it may be the results of the long time inflammatory stimulation in the vocal cord process.Arytenoid cartilage sclerosis in patients with LCG can be used to differentiate the disease from other laryngeal diseases in imaging analysis.2.The advantages of vocal fold intralesional steroid injection through TH approach are wide injection vision,easy to operate,good tolerance of the patients and high successful injection rate.It should be recommended for treatment of vocal process granuloma.3.PPIs and the intralesional steroid injection combined with PPIs therapy are all effective for laryngeal contact granuloma,the later can obviously shorten the cure time. |
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