Comparison of treatment modalities for contact granuloma: a nationwide multicenter study.

OBJECTIVES/HYPOTHESIS: This study evaluated the efficacy of commonly used treatment modalities and determined predictors of treatment outcome for contact granuloma.

STUDY DESIGN: Retrospective study.

METHODS: Twenty otolaryngologists from 18 university hospitals reviewed the medical records of their own contact granuloma patients for the most recent 4 years. To be enrolled as a valid case, each treatment had to continue for at least 3 months. After excluding intubation granuloma, 590 cases of contact granuloma were analyzed. Treatment outcomes were assessed as complete response (CR), marked response (MR), partial response (PR), and no response. The chi-square test was used to compare the efficacy of each treatment modality and logistic regression to determine the predictors of treatment outcome.

RESULTS: The long-term outcomes of good response (GR) (sum of CR and MR) rates after each treatment were 20.5% for observation, 31.6% for steroid inhalation, 44.0% for proton pump inhibitor (PPI), 44.3% for voice therapy, 60.0% for surgical removal, and 74.2% for botulinum toxin injection. Voice therapy, PPI, and botulinum toxin had more good responses than simple observation for the long-term outcome (P < 0.05). Surgical removal had a significantly higher recurrence rate (37.1%) than simple observation (10.3%) (P < 0.05).

CONCLUSIONS: Voice therapy or PPI are recommended as first-line treatments. Surgical removal should be reserved for selected patients because of the high chance of recurrence. Botulinum toxin injection can be used not only for primary cases but also for refractory cases with an expected high response rate.