Patient Factors Associated with the Development of Intubation Granulomas

Abstract

Objectives:

While there is a well-documented association between intubation and laryngeal granuloma development, not every intubation results in granulomas. We identify patient factors associated with the development of laryngeal granulomas after endotracheal intubation and analyze the efficacy of different treatment interventions on granuloma resolution.

Methods:

A retrospective review of the medical records of patients treated for laryngeal granulomas after endotracheal intubation at 2 tertiary care centers between 2005 and 2013 was performed. Medical comorbidities, peri-intubation medications, and treatment modalities and outcomes were recorded. Fisher exact test was used to compare patients with laryngeal granulomas to matched control patients who did not develop granulomas after intubation. Efficacy of treatment modalities was also analyzed.

Results:

Twenty-three patients with laryngeal granulomas after intubation were identified and compared with controls. There was a statistically significant association between the development of laryngeal granulomas and hypertension/cardiovascular disease, obesity, renal disease, and gastroesophageal reflux (P < .05). Diabetes mellitus (P = .137), tobacco use (P = .253), alcohol consumption (P = .304), peri-intubation steroid administration (P = .339), and antibiotic administration (P = .187) were not statistically significant. Of the granuloma patients, 13 achieved remission after treatment. Remission was achieved with surgical excision in 69.2%, with or without intraoperative steroid injection (38.4% and 30.8%, respectively). Proton pump inhibitor therapy alone was successful in 23.1%, and 7.7% resolved with inhaled steroids alone.

Conclusions:

Patient comorbidities likely play a role in the development of laryngeal granulomas after endotracheal intubation, while peri-intubation medications and tobacco/alcohol use do not appear to significantly impact development. Surgical excision was most effective in achieving remission.