Key Clinical Message
This case confirms the role of psychological stress in the pathogenesis
of laryngeal granulomas, that can reach huge dimensions causing airway
patency obstruction in rare cases.
Laryngeal granulomas
are commonly considered related to laryngopharyngeal reflux and voice
abuse, but the pathogenesis is still controversial.1
A 21-years-old male
underwent videolaryngoscopy in our ENT service for persistent dysphonia,
effort dyspnea, globus sensation, and chronic throat clearing with
progressive worsening. In the previous three years he had undergone
three microlaryngoscopic removals of a huge laryngeal granuloma.
His first symptoms
arose at the age of eighteen after an extreme psychological stress, when
his 5-years-old brother suffered from a devastating hemorrhagic stroke.
Videolaryngoscopy demonstrated a bulky whitish granulomatous lesion
rising from the medial surface of the left arytenoid and ventricular
band [Figure 1]. The supraglottis was significantly obstructed.
Medical treatments (steroids and proton pump inhibitors) and voice
therapy determined no improvements.
The mass was removed under direct microlaryngoscopy by cold instruments
and electrocoagulation of its vascular pedicle [Figure 2], and a 0.5
ml of triamcinolone suspension was injected into its base.
Histopathology of the lesion showed squamous mucosa with underlying
granulation tissue and acute inflammation, compatible with laryngeal
pyogenic granuloma.
After surgery, psychotherapy and further voice therapy were advised; no
recurrence of mass was found at the 12 months follow-up [Figure 3].
The described case confirms the relevance of psychological stress in the
pathogenesis of laryngeal granulomas.2