喉 - 插管后接触喉的肉芽肿

                               
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This video show endoscopy of larynx in young adult .
He presented to me with change in voice & hoarseness.
He gives history of intubation for 4 days , 1 month back for medical illness with respiratory failure in other hospital .
He also gives history of Post nasal discharge & GERD .

Video laryngoscopy show contact granuloma on medial portion of vocal process in right side & minute on other side with swollen epiglottis .

Contact Granuloma :

Contact granulomas are benign lesions of the larynx usually occurring from irritation of laryngeal structures on the vocal process of the arytenoid cartilage, where the mucosal covering is a thin layer of stratified squamous epithelium. This thin layer of epithelium is susceptible to being crushed between any object (e.g., an tracheal tube or nasogastric tube) inserted into the glottis and the cartilage beneath it, leading to an inflammatory process and benign granuloma development.

Presentation :
Symptoms include the following:
Varying degrees of hoarseness and a low-pitched, pressed voice quality
Cough
Throat clearing
Pain, especially on pressed phonation or with cough or throat clearing
A rough foreign body sensation
The physician inquiry includes the following:
Intubation history, including nasogastric intubation
Reflux and associated high-risk habits (eg, dietary habits, caffeine intake)
Vocal use patterns (eg, glottal fry, hard glottal attack)
Pulmonary characteristics (eg, chronic cough, use of inhalers)

They are more likely to occur if intubation has been difficult; with larger tracheal tubes and when tracheal tube cuff pressures are raised.

Treatment :
In most instances, conservative treatment involving lifestyle changes, cessation of smoking, speech therapy, and proton pump inhibitor therapy resolves most symptoms with gradual disappearance of the granuloma in 3-6 months.
Sometimes, however, the granulomas can be slow to regress and symptoms persist; in these instances, more invasive management including botulinum toxin type A injections or Surgery may be required.

Thanks !!!