Management of Vocal Process Granuloma: A Systematic Review and Meta-analysis

Summary

This meta-analysis evaluated the effectiveness of conservative and surgical treatments for vocal process granuloma by comparing response and recurrence outcomes across published studies. The study also assessed the relative outcomes of different therapeutic combinations and management strategies.

Abstract

Vocal process granuloma is a benign laryngeal lesion associated with high recurrence rates, and the optimal management strategy remains uncertain due to heterogeneous treatment approaches and variable outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of available conservative and surgical modalities, either in isolation or in combination, for the treatment of vocal process granulomas. Following PRISMA guidelines, PubMed, Scopus, Web of Science, Cochrane, and EMBASE databases were searched. Retrieved studies were screened according to predefined eligibility criteria, and two authors independently extracted data from the included studies. A total of 49 studies involving 2,818 patients were included, of which 29 studies reported overall response rates. Among these, 5 studies used surgical intervention and demonstrated a pooled rate ratio (RR) of 0.70, whereas 24 studies used conservative treatment and demonstrated a pooled RR of 0.83. In addition, four studies evaluated the use of botulinum toxin combined with proton pump inhibitors (PPI), showing a complete response rate of 0.756. Recurrence rates were assessed in 22 studies, including 14 on conservative treatment and 8 on surgical treatment, with pooled recurrence rates of 0.09 and 0.59, respectively. Three studies using PPIs combined with voice therapy demonstrated a recurrence rate of 0.009. Overall, conservative treatment was associated with improved symptom outcomes and lower recurrence rates compared with surgery alone, although interpretation is limited by heterogeneity and variability in protocols. Combinations of voice therapy with PPIs or botulinum toxin A injections with PPIs were associated with favorable outcomes in several studies. Surgery remains an important option for large or resistant granulomas; however, adjunctive nonsurgical treatment may help reduce recurrence. Further large, randomized trials are needed to minimize selection bias and strengthen the validity of these findings.

Introduction

A vocal process granuloma, also known as a laryngeal contact granuloma, is a benign hyperplastic lesion that occurs mostly in the arytenoid cartilage¹. This condition is rare but has a high recurrence rate (between 37%–92%)^2,3,4,5. Vocal process granulomas are more frequently encountered among males and are predominant among individuals in their 40s and 50s^6,7,8,9,

Protocol

The study followed the design principles outlined in the Cochrane Handbook for Systematic Reviews of Interventions and adhered to the reporting standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines^29,30. The study protocol was registered using PROSPERO (registration number: CRD42024512257). This systematic review and meta-analysis were based exclusively on data from previously published studies; therefore, ethical approval and informed consent were not required. The completed PRISMA 2020 checklist is provided as Supplementary File 1.<....

Results

Literature search results
We performed a comprehensive literature search across five databases, identifying 1,828 studies. After removing duplicates, 994 studies remained eligible for further assessment. By screening titles and abstracts, we identified 75 articles suitable for a more in-depth evaluation. Of these, 26 articles were excluded, ultimately including 47 articles that met our meta-analysis criteria^{2,3,4<.......}

Discussion

A diverse range of treatment modalities is available for vocal process granulomas. However, no consensus has been reached on the ideal treatment modality. We conducted a systematic review and meta-analysis to evaluate the efficacy of conservative and surgical treatment options, both in isolation and in combination, for vocal process granuloma. Our evaluation depended on both the treatment response and recurrence rates. Our analysis included data from 49 studies, comprising 42 cohort studies and 7 case series, with a tota.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Open Meta-Analyst	Center for Evidence Synthesis in Health, Brown University, Providence, RI, USA	—	Single-arm meta-analysis
Review Manager (RevMan)	The Cochrane Collaboration, London, UK	version 5.4	Indirect comparative meta-analysis