Hi

Thanks for the query

1. What are the chances of this granuloma being a malignant lesion?
A: With regards to the past history of smoking, your age and the acid reflux, the probability of granuloma turning malignant is approximately 25-30%.

2. Is clinical diagnoses pretty reliable?
A: Yes, if the granuloma has been identified after doing a scopy of the larynx, it is reliable.

3. I was told to return in a month following treatment for reflux.
A: If the grauloma is secondary to the acid reflux disease, it will reduce in size after taking the medicines. If it does not, then the biopsy of the same is advisable to rule out malignancy.

4. However I would like to know if this finding could lead to other issues with the larynx such as cancer?
A: As I mentioned in the first answer, considering the predisposing factors, the chances of malignancy cannot be ruled out. But, it is better to try with medications for acid reflux and then go ahead with further investigations.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Thanks for writing back

1. So you suggest that it may still be a malignant lesion?
A: Even though vocal cord granulomas are benign in nature, owing to the predisposing factors, a possibility of malignancy cannot be ruled out. It would be wiser to take the necessary medicines such as proton pump inhibitor and prokinetic for the treatment of the same. Wait and watch for a month, if it does not relieve then you will require a biopsy of the lesion, to confirm it is benign.

2. My point is how reliable is clinical diagnoses in this case?
A: As you don't have any other features of malignancy (such as hoarseness, difficulty in breathing and weight loss) this lesion has to be initially considered as benign and treated accordingly.

3. Is 20to30 % chance pretty high even though clinically it looks benign?
A: Yes, the percentage of malignant transformation is definitely high even though the lesion looks benign.

4. If I didn't have any pathology present such as this granuloma would you still believe the chances of malignancy about 20 to 30% with my past history and reflux or the finding of granuloma is a predictor of future problems with laryngeal cancer.
A: Not all smokers will land up in malignancy until they have any identifiable lesions. The chances of malignancy are about 20-30% with the identification of the granulomatous lesion.

Usually, for smokers, the risk of the development of laryngeal cancer decreases after the cessation of smoking, but remains elevated even years later when compared to that of nonsmokers. In USA, the incidence is five in 100,000.

Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi,

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Regards,

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