(0823) Management of the Vocal Cord Granuloma: A Systematic Review and Meta-analysis

Introduction: : The purpose of this study was to evaluate the efficacy of available conservative and surgical modalities in isolation or combination for the treatment of vocal process granulomas.

Methods: Our data sources were The PRISMA guidelines, PubMed, Scopus, Web of Science, Cochrane, and EMBASE databases. Electronic databases and registries were comprehensively searched. The retrieved studies were screened based on predefined eligibility criteria. Two authors independently extracted data from the included studies.

Results: In our meta-analysis of 50 studies involving 2,833 patients with vocal cord granulomas, 29 reported overall response rates. Among them, 5 used surgical intervention with a pooled rate of 70%, while 24 studies used conservative treatment with a Pooled RR of 83%. Moreover, four studies investigate the use of botulinum toxin and proton pump inhibitor (PPI) showing a response rate of 75.6%. The recurrence rate was assessed in 22 studies (conservative treatment: 14; surgical treatment: 8). The pooled RR for the two groups was 9% and 59%, respectively. In the conservative and surgical treatment subgroups, three studies used PPI and voice therapy, and the recurrence rate was 0.9%.

Conclusions: Our analysis showed superior symptom improvement and lower recurrence rates with conservative treatment compared to surgery. Combining voice therapy with PPIs or using botulinum toxin A injections with PPIs yielded the most favorable outcomes. Surgery remains necessary for large and resistant granulomas; however, it should be followed by nonsurgical treatment to avoid recurrence. Large, randomized trials are required to reduce the selection bias and increase the validity of these results.