Laryngeal granuloma – experience of the ENT clinic of ”Timofei Mosneaga” Republican Clinical Hospital

Abstract

Vocal fold granuloma is a benign laryngeal lesion located at the vocal processes of the arytenoid cartilages and characterized by the formation of granulation tissue as a response to chronic mucosal irritation. Material and methods. A retrospective analysis of data from 12 patients diagnosed with laryngeal granuloma and treated between 2019 and 2024 at the ENT Clinic of the “Timofei Moșneaga” Republican Clinical Hospital. Results. In the examined series, males predominated (58.33%). Age distribution showed a bimodal pattern: 16–30 years (33.3%) and 41–50 years (33.3%). The clinical presentation was dominated by dysphonia (58.3%), foreign body sensation (41.66%), and irritative cough (50%). Most patients sought medical care more than one month after symptom onset (41.66% of cases). Constant vocal abuse was associated with 41.66% of cases, gastroesophageal reflux disease (GERD) with 33.3%, intubation with 16.6%, and 1 case (8.35%) was idiopathic. Morphologically, medium-sized granulomas predominated (66.6%), followed by microgranulomas (25%) and large granulomas (8.35%). Conservative therapy proved effective in the vast majority of cases, 9 of 12 patients (75%). A favorable outcome after CO₂ laser ablation assisted by jet ventilation was observed in 66.6% of the patients undergoing the procedure (1 recurrence among 3 operated cases). Conclusions. Conservative treatment (proton pump inhibitors, corticosteroids—3 days intramuscularly followed by 7 days inhalation, proteolytic enzymes, NSAIDs, antihistamines, and phoniatric therapy) represents the initial treatment option for laryngeal granulomas. Surgery is reserved for symptomatic, treatment-refractory, or recurrent cases. Late presentation, likely associated with the gradual increase in granuloma size, combined with gastroesophageal reflux disease, increases the probability of conservative treatment failure and the need for surgical intervention.