A 35-year-old man develops persistent throat pain and hoarseness several weeks after prolonged intubation for head injury. Endoscopy shows a smooth, ulcerated mass over the posterior third of the left vocal cord at the junction with the vocal process of the arytenoid. Biopsy shows granulation tissue with no dysplasia. First-line management is:
- A Wide local excision with CO2 laser immediately
- B Proton pump inhibitor therapy, voice rest and correction of intubation-related factors ✓
- C Radiotherapy to the larynx at 60 Gy
- D Type I Isshiki thyroplasty
Correct answer: B. Proton pump inhibitor therapy, voice rest and correction of intubation-related factors
Explanation
This is a contact granuloma (vocal process granuloma) arising from endotracheal tube trauma over the thin perichondrium of the vocal process. Conservative management with a proton pump inhibitor to reduce reflux-associated irritation, voice hygiene and removal of aggravating factors resolves most lesions. Surgery risks recurrence unless the underlying cause is corrected, radiotherapy is reserved for proven malignancy, and thyroplasty addresses cord paralysis rather than a granuloma.
Reference: Scott-Brown's Essential Otorhinolaryngology, 1st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.