Injection of the steroid Kenalog™, usually into inflammatory lesions. Kenalog™ is the trade name for a suspension of triamcinolone acetonide, a steroid that is eight times more potent, milligram for milligram, than prednisone. In laryngology, Kenalog™ at 40mg per ml is injected into the greater cornua of the hyoid bone to treat the condition hyoidynia, or into areas of inflammatory stenosis, or (occasionally) into symptomatic and very large contact granulomas, or (even less commonly) into vocal cords with rheumatoid nodules.
Granulomas Mature and Fall Off by Themselves, But Steroid Injection Can Help…
"Third" granuloma (1 of 6)
This man has had a granuloma removed twice elsewhere. As expected it recurred both times, so that in a sense, this is the “third” granuloma. It has the typical bi-lobularity (U = upper; L = lower).
Injection into lower lobe (2 of 6)
Occasionally a steroid injection is used for the small percentage of persons with granuloma who are symptomatic. Here, note the needle inserted into the lower lobe (L, right of photo) to infiltrate triamcinolone.
Injection into upper lobe (3 of 6)
Now the needle has been redirected into the upper lobe (U). This procedure is done under topical anesthesia in the voice laboratory.
Five weeks later (4 of 6)
About 5 weeks later, the patient’s symptoms have gone away. The granuloma has shrunk by as much as 50% comparing with photo 1.
Six months post-injection (5 of 6)
Now six months after the steroid injection, not only steroid, but also maturation of the granuloma continues. Compare with photos 1 and 4
One year post-injection (6 of 6)
Now a year after the steroid injection, the granuloma has finished its maturation process and is gone. Only a subtle residual elevation is visible.
