A 38-year-old woman on prolonged ICU ventilation develops severe odynophagia and hoarseness after extubation. Laryngoscopy shows a smooth, unilateral, pedunculated inflammatory mass over the vocal process of the arytenoid. The most appropriate initial management is:
- A Proton pump inhibitor therapy with voice rest and speech therapy ✓
- B Immediate surgical excision with CO2 laser
- C Intralesional triamcinolone injection alone
- D Type I thyroplasty
Correct answer: A. Proton pump inhibitor therapy with voice rest and speech therapy
Explanation
This is a contact granuloma (vocal process granuloma), arising from mucosal injury over the thin perichondrium of the vocal process, typically due to intubation trauma compounded by laryngopharyngeal reflux. Initial management is conservative: proton pump inhibitor therapy, voice hygiene, and speech therapy, with excision reserved for persistent or obstructive lesions, and recurrence is common after surgery. Thyroplasty addresses paralysis and has no role here.
Reference: Scott-Brown's Essential Otorhinolaryngology, 2nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.