Vocal cord granuloma
| Classification according to ICD-10 | |
|---|---|
| J38.3 | Other diseases of the vocal folds - granuloma |
| ICD-10 online (WHO version 2019) | |
A vocal cord granuloma or vocal cord granuloma is a pseudotumor of a vocal cord that consists of granulation tissue . The cause of the granuloma formation is almost always an injury to the vocal cord. Vocal cord granulomas can be unilateral or bilateral.
causes
According to the most common causes, a distinction is made between postoperative vocal cord granuloma after surgery on the larynx and intubation granuloma after (long-term) intubation from contact granuloma , which is caused by overuse of the vocal cords. Only rarely can none of the above-mentioned causes be found for a vocal cord granuloma.
Postoperative vocal cord granulomas are found after surgical interventions on the larynx, such as partial resections, and less often after laryngeal microscopic interventions.
The intubation granuloma occurs most frequently after long-term intubation, but can in principle occur after every intubation, i.e. after every operation under general anesthesia, or even after a bronchoscopy. An epithelial defect on the vocal folds is assumed to be the cause if patients cough or press during intubation. Intubation granulomas are almost always found in the posterior third of the vocal folds, in the area of the vocal process of the control cartilage .
The contact granulomas are also found in the area of the vocal process . Contact granulomas are caused by chronic overuse of the voice in the context of a functional voice disorder or, more rarely, acute overuse. The tips of the two processus vocales hit each other "like hammer and anvil", which results in superficial lesions of the mucous membrane, which in turn are the starting point for the granulation tissue.
Specific granulomas are rare in tuberculosis , sarcoid , syphilis and Wegener's granulomatosis .
Symptoms
In the foreground of the symptoms is a more or less pronounced hoarseness, furthermore a foreign body sensation and throat clearing is not uncommon.
diagnosis
During the larynxoscopy or the examination with a magnifying laryngoscope, pale reddish to dark red, often spherical structures are found, usually on the free edge of the vocal folds and in the back third of the vocal cord, which in the case of intubation granulomas can be pea-sized and also pedunculated. Such pedunculated granulomas can occasionally tear off and be swallowed or coughed up, which can lead to spontaneous healing. Under the surgical microscope one can see that intubation granulomas are not covered by epithelium .
Contact granulomas are found at a corresponding point in the rear third of the vocal cord, often asymmetrically, as the protruding granuloma on one side presses into a groove on the opposite side during phonation . In the course of scarring changes, contact granulomas can be covered by epithelium, which in individual cases can also show cornification .
There is no risk of malignant degeneration with granulomas of the vocal folds.
therapy
Vocal cord granulomas are usually surgically removed using a laryngeal microscope. They tend to recur , which is understandable, since the surgical removal creates an epithelial defect again. For contact granulomas, the mere ablation is usually not enough; it must be accompanied by intensive speech therapy treatment of the underlying voice disorder.
literature
- O. Kleinsasser: Microlaryngoscopy and endolaryngeal microsurgery. Technique and typical findings . Schattauer, 1991, ISBN 3-7945-1381-9 .
- H. Naumann (Ed.): Oto-Rhino-Laryngologie in Clinic and Practice. Volume 3: neck . Thieme, Stuttgart 1995, ISBN 3-13-676701-2 .
