Laryngopharyngeal reflux disease management for recurrent laryngeal contact granuloma: A case report

Abstract

Background: Laryngeal contact granuloma (LCG) is difficult to treat and frequently associated with high persistence and recurrence, despite the availability of both surgical and pharmacological treatment options. An appropriate strategy is therefore needed to help patients with multiple recurrences of LCG to potentially avoid unnecess-ary surgery.

Case summary: We describe the case of a 34-year-old male patient with recurrent LCG in which a good response was achieved through successful management of laryngophar-yngeal reflux disease using a combination pharmacotherapeutic regimen consisting of anti-reflux therapy, pepsin secretion inhibition, bile acid neutralization, and lifestyle modifications. This patient underwent surgery to excise the granuloma, then relapsed, underwent a second surgery, which was followed by a second recurrence. The granuloma then disappeared after 9 mo of combined treatment with ilaprazole enteric-coated capsules (10 mg qd), mosapride tablets (5 mg tid) and compound digestive enzyme capsules (2 tablets). The drug regimen was discontinued after one year, and no recurrence of the lesion has been reported during the one-year follow-up period.

Conclusion: We report a combination of pharmacotherapeutics and lifestyle modifications for the management of laryngopharyngeal reflux disease to address recurring LCG.

Keywords: Anti-reflux therapy; Bile acid neutralization; Case report; Laryngopharyngeal reflux disease management; Pepsin secretion inhibition; Recurrent laryngeal contact granuloma.

Figure 1

Laryngeal contact granuloma before the first operation. A: A laryngeal contact granuloma (LCG) initially presented with a lesion on the left vocal process; B: The LCG was removed in the first operation; C: The first pathological result: (left vocal cord mass) mucosal ulcer with inflammatory granulation tissue polypoid hyperplasia.

Figure 2

Relapse-reoperation-recurrence. A: Two months after granuloma excision, re-examination by laryngoscopy revealed that the left vocal cord granuloma had recurred; B: Three months after granuloma excision, re-examination by laryngoscopy revealed that the left vocal cord granuloma had recurred; C: After the second surgical intervention, the laryngeal contact granuloma (LCG) was again removed; D: The second pathological result was consistent with the first result; E: Three months after the second surgery the LCG recurred at the edge of previous lesion under a treatment regimen of rabeprazole enteric-coated capsules (20 mg bid) combined with mosapride tablets (5 mg tid) for 8 wk; F: A laryngoscopic review revealed no change in LCG size following 12 wk of ilaprazole enteric-coated capsules (10 mg qd) and mosapride tablets (5 mg tid) administration.

Figure 3

Disappearance and no recurrence. A: The size of the laryngeal contact granuloma (LCG) was reduced at three months after initiating a new anti-reflux regimen consisting of a combination of ilaprazole enteric-coated capsules (10 mg qd), mosapride tablets (5 mg tid) and compound digestive enzyme capsules (2 tablets); B: LCG was undetectable six months after starting the cocktail therapy; C: No recurrence of the granuloma was observed six months after the patient discontinued medications; D: No recurrence of the granuloma after the patient had discontinued therapy for 1 year.