(704) Clinical Outcomes of Office-based Management for Vocal Process Granulomas: A Systematic Review

Introduction: Vocal process granulomas (VPGs) are benign inflammatory lesions with various etiologies and clinical courses. This systematic review compares outcomes in office-based management in adults with VPGs.

Methods: This PRISMA-guided systematic review included studies published through December 2025 evaluating office-based treatments for adult VPGs of various etiologies in outpatient laryngology clinics. Interventions included observation, voice therapy(VT), antireflux therapy, inhaled corticosteroids, zinc, intralesional steroid injection, botulinum toxin(BTX) injection, laser ablation, and combination approaches. Outcomes included complete resolution, recurrence rate, time to resolution(TTR), escalation to operative intervention, and adverse events. Data extraction and statistical analysis using the Kruskal-Wallis H test were completed in January 2026.

Results: Across 50 studies, 2,398 patients were included. There were no significant differences in complete resolution (p=0.32), recurrence rate (p=0.382), or escalation to operative intervention (p=0.575) between treatment groups. However, the TTR among groups trended toward significance, (p=0.056, CI [4.57, 5.43]) months, among groups. BTX resulted in the shortest mean TTR, 2.19 months, whereas VT had the longest, 8 months. However, only BTX consistently reported adverse effects with 51% of patients noting effects such as dysphonia (including breathiness).

Conclusions: Across office-based interventions for VPGs, there is similar efficacy amongst interventions, however there are varying TTR and adverse effect profiles. Though BTX offers rapid symptom improvement, its side effects may deter some from this intervention. Thus, management should be guided by shared-decision making that incorporates patients’ goals and preferences.