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December 1992

Should Granulomas Be Excised in Children With Long-term Tracheotomy?

Author Affiliations

From the Departments of Otolaryngology and Pediatrics, Children's National Medical Center and George Washington University School of Medicine, Washington, DC (Dr Rosenfeld); and the Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh (Pa) (Dr Stool). Dr Rosenfeld is now with the Departments of Otolaryngology, Long Island College Hospital, Brooklyn, NY, and the State University of New York Science Center at Brooklyn.

Arch Otolaryngol Head Neck Surg. 1992;118(12):1323-1327. doi:10.1001/archotol.1992.01880120049010

• We reviewed 265 rigid bronchoscopies performed in 50 children with tracheotomy-dependent subglottic stenosis (25 congenital, 25 acquired). Granulomas developed in 40 children (80%) and were unrelated to age, sex, race, gastroesophageal reflux, tracheotomy duration, or type of stenosis. The incidence of small to medium, large, and obstructing granulomas at endoscopy was 28%, 6%, and 0%, respectively. Compared with a baseline finding of no granuloma at preceding bronchoscopy, the odds of granuloma recurrence were 3.0 after an unexcised granuloma (95% confidence interval [CI], 1.1 to 8.4), 4.1 after granuloma excision (95% CI, 1.4 to 11.9), and 7.3 after expansion surgery (95% CI, 1.1 to 49.2). Considering the low incidence of large or obstructing granulomas, and the failure of granuloma excision to diminish recurrence, we do not recommend interval excision of nonobstructing granulomas in children with stable tracheotomies.

(Arch Otolaryngol Head Neck Surg. 1992;118:1323-1327)

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