The Journal of Laryngology & Otology

Main Article

Botulinum toxin as adjunctive therapy in refractory laryngeal granuloma

E J Damrosea1 c1 and J F Damrosea2

a1 Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, CA, USA

a2 Department of Otolaryngology, The Permanente Medical Group, Inc., Fresno, CA, USA


Objective: This study evaluated the role of botulinum toxin type A in the treatment of refractory laryngeal granulomas.

Study design and setting: Retrospective clinical review at a tertiary care hospital. Seven patients with vocal process granulomas underwent percutaneous injection of botulinum toxin into both vocal folds, performed in an office setting. Total doses ranged from 10 to 25 U, divided between both vocal folds.

Results: All patients experienced resolution of their granulomas over two to seven weeks. No patient developed aspiration pneumonia. All patients experienced hoarseness secondary to the injections, but voice quality returned to baseline in all patients as the toxin was degraded.

Conclusions: Botulinum toxin is safe and effective therapy in resolving vocal process granulomas in patients refractory to traditional therapy. The optimal treatment dose remains to be determined.

Significance: Percutaneous botulinum toxin injection is helpful in resolving laryngeal granulomas.

(Accepted June 25 2005)

(Online publication October 02 2007)


c1 Address for correspondence: Dr Edward J Damrose, Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, 801 Welch Road, Stanford, CA 94305, USA. Fax: 650 725 8502 E-mail:


Presented in part as a poster at the American Bronchoesophagological Association Annual Meeting, 14 May 2005, Boca Raton, Florida, USA.

Dr E J Damrose takes responsibility for the integrity of the content of the paper.

Competing interests: None declared