الفهرس 
Vocal Fold AnatomyOnly 14 pages are availabe for public view
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Abstract
Granulomas of the vocal process of the larynx are benign lesions of the posterior glottis generally centered over the tips of the cartilaginous vocal processes. Clinically they are associated with odynophagia, throat clearing, globus, and otalgia.
The pathogenesis of contact granulomas is not clear they are thought to occur as the result of inflammation that produces granulation tissue at the site of the ulceration. Several etiological factors have been suggested as vocal abuse habitual throat clearing, low pitched voice, laryngopharyngeal reflux, psychosomatic disorder, smoking, post nasal drip and throat infection.
Treatments of these lesions are focuses on four primary lines: Prevention, voice therapy, medical therapy, and surgical excision. Prevention is achieved by avoidance of long term orotracheal intubation, use of smaller endotracheal tubes, and use of histamine-2 receptor blockers in patients intubated for prolonged periods have all been reported as helpful in decreasing laryngeal trauma.
Various voice therapy techniques have been reported in the literature with varying degrees of success. Bloch reported complete resolution of granulomas in 64% of patients treated with voice therapy. (Bloch GS et al., 1981).
Medical treatment has included antibiotics, steroids(systemic, inhaled, or locally injected), antacids, histamine-2 receptor blockers, proton pump inhibitors, Botulinum toxin (Botox) injections,Surgical excision although still commonly performed, has been shown to have a high incidence of recurrence. The method of choice in most centers is endoscopic removal with the carbon dioxide (CO2) laser.
Botulimun toxin type A is aneurotoxin produced by the anaerobic gram-positive bacterium clostridium botulinum its site of action is the neuromuscular junction and the end result is blockage of the neurotransmission by acetylcholine.
It was first introduced as a new therapy in the treatment of laryngeal granulomas by Nasri et al in 1995 which was injected into one or both vocal folds to induce temporary vocal fold paresis allowing resolution of granulomas.
In our meta-analysis we aimed to detect the efficacy and safety of BTA injection for treatment of vocal fold contact granulomas.
Our study included eight articles published from 1995 to 2015 which included 713 patients on which analysis was done using MedCalc© version 15.8 MedCalc© Software bvba, Ostend, Belgium.
The study revealed good response to treatment with BTA 92.9% improvement, 7% failure rate, 5.4% relapse rate and 0.16% decreased valsalve effort.