Intubation granuloma

Intubation Granuloma is a benign pathology characterized by the formation of granulomas in the larynx, specifically on the vocal cords, as a result of irritation and trauma caused by endotracheal intubation. This condition is also known as contact ulcer granuloma or intubation-induced granuloma. It is a relatively rare but significant complication that can arise after an individual has undergone mechanical ventilation with an endotracheal or tracheostomy tube, especially if the intubation period was prolonged.

Etiology

Intubation granulomas are caused by the direct physical trauma and pressure exerted by the endotracheal tube on the mucosal lining of the larynx, leading to ulceration and subsequent granuloma formation. Factors contributing to the development of intubation granulomas include the size of the endotracheal tube, duration of intubation, movement of the tube, and individual susceptibility to injury.

Symptoms

The clinical presentation of an intubation granuloma includes hoarseness, dysphonia, throat pain, and sometimes difficulty breathing or dyspnea if the granuloma is large enough to obstruct the airway. Patients may also experience a sensation of a foreign body in the throat.

Diagnosis

Diagnosis of intubation granuloma is primarily based on the patient's medical history and laryngoscopic examination. During laryngoscopy, a granuloma appears as a reddish, irregular, and exophytic lesion located on the posterior part of the larynx, often on the vocal processes of the arytenoid cartilages.

Treatment

Treatment options for intubation granuloma include conservative management, pharmacotherapy, and surgery. Conservative management involves voice rest, humidification, and treatment of any concurrent acid reflux with proton pump inhibitors. Pharmacotherapy may include corticosteroids to reduce inflammation. Surgical removal is considered for granulomas that do not respond to conservative treatment or are causing significant airway obstruction.

Prognosis

The prognosis for patients with intubation granuloma is generally good, especially with early detection and treatment. However, recurrence is possible, particularly if the underlying causes, such as gastroesophageal reflux, are not addressed.

Prevention

Preventive measures focus on minimizing trauma during intubation by using appropriately sized endotracheal tubes, ensuring proper placement, and limiting the duration of intubation whenever possible. Management of risk factors, such as acid reflux, is also important to prevent recurrence.

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