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Laryngeal granulomas remain notorious for their tendency to recur after surgical removal. Although high rates of complete remission have been reported with use of the potassium-titanyl-phosphate (KTP) laser, this equipment is expensive and not available in all units performing ENT surgery. Radiofrequency coblation by contrast is increasingly being utilised in many ENT departments. This prospective case series study reviewed the outcomes of 13 patients affected by laryngeal granulomas secondary to prolonged intubation treated with coblation from June 2016 to January 2019. In terms of technique, the initial energy setting used was 7 (plasma setting). A small amount of tissue was sent for histological analysis, and the granuloma and perichondrium ablated to an appropriate depth, with care taken to prevent cartilage damage. Steroid atomising inhalation and voice rest were prescribed for three days after surgery. The primary recorded outcome was the extent of removal and complete remission at six months postoperatively as assessed by videolaryngoscopy. Complication rates and voice outcomes according to the GRBAS scale were also evaluated. In this series, the complete remission rate was 13/13 (100%). In keeping with this, improvement was noted in all mean perceptual voice parameters postoperatively (p < 0.05). No complications were recorded. This study is clearly limited by small numbers and the absence of a control group. Nevertheless, it is plausible that with the lower temperatures associated with coblation techniques combined with better visualisation relative to cold steel excision, coblation would potentially be associated with better outcomes in the treatment of laryngeal granulomas relative to either cold steel removal or CO2 laser excision.

Radiofrequency ablation of intubation granulomas.
Ding J, Jiang Z, Lou Z.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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