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An endoscopic grading system for vocal process granuloma

Published online by Cambridge University Press:  03 March 2008

D G Farwell*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
P C Belafsky
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
C J Rees
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
*
Address for correspondence: Dr D Gregory Farwell, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA. E-mail: gregory.farwell@ucdmc.ucdavis.edu

Abstract

Background:

A reliable grading system allows the clinician to classify disease severity, monitor progress and evaluate treatment efficacy. There is no currently accepted grading system for vocal process granuloma of the larynx.

Aim:

To evaluate the reliability of a new grading system for vocal process granuloma.

Methods:

All vocal process granuloma images from a digital laryngeal image library were abstracted. Granulomas were graded on a one to four system, as follows: grade one, sessile, non-ulcerative granuloma limited to vocal process; grade two, pedunculated or ulcerated granuloma limited to vocal process; grade three, granuloma extending past vocal process but not crossing midline of airway in fully abducted position; and grade four, granuloma extending past vocal process and past the midline of the airway in the fully abducted position. The granulomas were additionally graded A if unilateral and B if bilateral. Two laryngologists and two otolaryngology residents rated the granulomas on two separate occasions. Intra- and inter-observer reliability was evaluated with the kappa (κ) test statistic.

Results:

Thirty-five vocal process granulomas were identified. The percentage intra-observer agreement for the two laryngologists was 97 and 100 per cent (κ = 0.94 and 1.00, respectively). The percentage inter-observer agreement between the two laryngologists was 91 per cent (κ = 0.83). The percentage intra-observer agreement for the two residents was 89 and 91 per cent (κ = 0.83 and 0.77, respectively). The percentage inter-observer agreement between the two residents was 83 per cent (κ = 0.67).

Conclusions:

The proposed grading system for vocal process granuloma displayed excellent intra- and inter-observer reliability among residents and experienced laryngologists.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2008

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Footnotes

Presented at the American Academy of Otolaryngology Annual Meeting, September, 20 2006, Toronto, Ontario, Canada.

References

1 Shin, T, Watanabe, H, Oda, M, Umezaki, T, Nahm, I. Contact granulomas of the larynx. Eur Arch Otorhinolaryngol 1994;251:6771CrossRefGoogle ScholarPubMed
2 Haggitt, RC. Histopathology of reflux-induced esophageal and supraesophageal injuries. Am J Med 2000;108:109111SCrossRefGoogle ScholarPubMed
3 Benjamin, B, Roche, J. Vocal granuloma, including sclerosis of the arytenoid cartilage: radiographic findings. Ann Otol Rhinol Laryngol 1993;102:756–60CrossRefGoogle ScholarPubMed
4 Miko, TL. Peptic (contact ulcer) granuloma of the larynx. J Clin Pathol 1989;42:800–4CrossRefGoogle ScholarPubMed
5 Hoffman, HT, Overholt, E, Karnell, M, McCulloch, TM. Vocal process granuloma. Head Neck 2001;23:1061–74CrossRefGoogle ScholarPubMed
6 Delahunty, JE, Cherry, J. Experimentally produced vocal cord granulomas. Laryngoscope 1968;78:1941–7CrossRefGoogle ScholarPubMed
7 Feder, RJ, Michell, MJ. Hyperfunctional, hyperacidic, and intubation granulomas. Arch Otolaryngol 1984;110:582–4CrossRefGoogle ScholarPubMed
8 Koufman, JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; April 101:178. PMID: 1895864CrossRefGoogle Scholar
9 Koufman, JA. Contact ulcer and granuloma of the larynx. Curr Ther Otolaryngol Head Neck Surg 1994;5:456–9Google Scholar
10 Wenig, BM, Heffner, DK. Contact ulcers of the larynx. A reacquaintance with the pathology of an often underdiagnosed entity. Arch Pathol Lab Med 1990;114:825–8Google ScholarPubMed
11 Luzar, B, Gale, N, Klopcic, U, Fischinger, J. Laryngeal granuloma: characteristics of the covering epithelium. J Laryngol Otol 2000;114:264–7CrossRefGoogle ScholarPubMed
12 Devaney, KO, Rinaldo, A, Ferlito, A. Vocal process granuloma of the larynx – recognition, differential diagnosis and treatment. Oral Oncol 2005;41:666–9CrossRefGoogle ScholarPubMed
13 Benaixa, JP, Esteban, F, Gonzalez-Perez, JM, Martinez-Garrido, R. Treatment of laryngeal granuloma with anti-extraesophageal reflux medication [in Spanish]. Acta Otorrinolaringol Esp 2003;54:501–5CrossRefGoogle ScholarPubMed
14 Hirano, S, Kojima, H, Tateya, I, Ito, J. Fiberoptic laryngeal surgery for vocal process granuloma. Ann Otol Rhinol Laryngol 2002;111:789–93CrossRefGoogle ScholarPubMed
15 Clyne, SB, Halum, SL, Koufman, JA, Postma, GN. Pulsed dye laser treatment of laryngeal granulomas. Ann Otol Rhinol Laryngol 2005;114:198201CrossRefGoogle ScholarPubMed
16 Zeitels, SM, Casiano, RR, Gardner, GM, Hogikyan, ND, Koufman, JA, Rosen, CA. Management of common voice problems: committee report. Otolaryngol Head Neck Surg 2002;126:333–48CrossRefGoogle ScholarPubMed
17 Lemos, EM, Sennes, LU, Imamura, R, Tsuji, DH. Vocal process granuloma: clinical characterization, treatment and evolution. Rev Bras Otorrinolaringol 2005;71:494–8. PMID: 16446966CrossRefGoogle ScholarPubMed
18 Benjamin, BB, Croxson, G. Vocal cord granulomas. Ann Otol Laryngol 1985;94:538–41CrossRefGoogle ScholarPubMed
19 Jaroma, M, Pakarinen, L, Nuutinen, J. Treatment of vocal cord granuloma. Acta Otolaryngol 1989;107:296–9CrossRefGoogle ScholarPubMed
20 Bloch, CS, Gould, WJ, Hirano, M. Effect of voice therapy on contact granuloma of the vocal fold. Ann Otol Rhinol Laryngol 1982;90:4852CrossRefGoogle Scholar
21 Jackson, C. Contact ulcer of the larynx. Ann Otol Rhinol Laryngol 1928;37:227–30CrossRefGoogle Scholar
22 Harari, PM, Blatchford, SJ, Coulthard, SW, Cassady, JR. Intubation granuloma of the larynx: successful eradication with low-dose radiotherapy. Head Neck 1991;13:230–3CrossRefGoogle ScholarPubMed