Comparison of the effects of esomeprazole plus mosapride citrate and botulinum toxin A on vocal process granuloma

Objectives

Vocal process granulomas have a high tendency for persistence despite many treatment alternatives. Anti-reflux medications or botulinum toxin A injections are the main current therapies. There are no studies that compare the effects on vocal process granuloma of proton pump inhibitors plus prokinetic agents with botulinum toxin A injections.

Study design

Prospective cohort study.

Methods

Adult patients reporting to our outpatient department complaining of trachyphonia and/or abnormal pharyngeal sensations who were found to have contact granulomas. Patients were divided into two groups according to the treatment: esomeprazole with mosapride citrate (n = 26) or botulinum toxin A injection (n = 20). The reflux symptom index and reflux finding score determined by electronic fibrolaryngoscopy were utilized to assess efficacy.

Results

Forty-six patients were recruited (43 male; 3 female). The mean age (range) was 48.3 years (38–69) and the body mass index was 23.51 kg/m² (19.13–27.89). Laryngopharyngeal reflux disease diagnosed by RSI or RFS was found in 18 and 27 patients, respectively, and 18 diagnosed without laryngopharyneal reflux disease. Twenty patients (95%) were cured in the esomeprazole with mosapride citrate group and nine (45%) in the botulinum toxin A group. Eleven (55%) patients had recurrence after botulinum toxin A injection, with an average interval of 3.1 months (range 1–6). The recorded symptoms after therapy resolved within 6 months with a statistically significant improvement in the esomeprazole with mosapride citrate group.

Conclusions

Combined proton pump inhibitor plus prokinetic drug therapy plays a significant role in the treatment of vocal process granulomas or after surgery.