Granulation tissue interfering with the prosthesis
Problem: granulation tissue is interfering with the voice prosthesis.
Formation of granulation tissue around the TE-fistula has been reported at a rate of approximately 5%. Mostly this is seen in conjunction with a local infection and treatment of such an infection will result in spontaneous disappearance of the granulation, as shown above. It is sometimes advisable to (temporarily) put in a longer prosthesis. If this is not the case or if immediate treatment is required in order to improve the voice, some sort of cauterization (electro-, chemo-, laser) of the area of the granulation may be considered. In conjunction with this, treatment with a broad-spectrum antibiotic is advisable. The figures right give an example of this: above priot to NdYAG laser excision, below the situation after 2 weeks. There is some circumstantial evidence of a causal relation between local infection and/or granulation tissue formation at the TEP site and gastroesophageal reflux. Therefore, it could be beneficial in treatment of refractory cases, to prescribe anti-reflux medication in order to break a ‘vicious circle’.