User:Reidh084/sandbox

I would like to increase the amount of information found in the treatment section and to perhaps expand it to also include a prevention or screening section, and outcomes or prognosis. To start with, I've found some articles that focus on differential diagnosis and identification, and of treatment approaches for different types and levels of severity, including personal factors.

Introductory paragraph

Contact granuloma consists of granulation tissue, not to be confused with granuloma.

Screening and Identification
Screening tools for contact granulomas are not currently available. Diagnosis of contact granulomas require visualization using laryngoscopy, and may require further biopsy for differential diagnosis. A combination of symptoms and lifestyle factors may be linked with the development of a contact granuloma, however symptoms vary greatly by individual. Some lifestyle factors that have been linked with elevated risk of development of contact granulomas include frequent use of the voice, especially when in loud environments, and concurrent use of the voice with alcohol consumption (increasing risk of gastroesophageal reflux symptoms). Contact granuloma may also arise after intubation, and so following intubation, patients should be monitored if voice symptoms arise. Symptoms may or may not include include hoarse voice, described as "huskiness" by some patients, "aching" in the throat related to increased effort to produce voice , and the feeling of having a lump in one's throat when swallowing. It is also possible to have no such symptoms, especially if the granuloma is small. A patient presenting with such symptoms a risk factors should therefore be referred for further visualization. It is therefore recommended to obtain a diagnosis from a doctor.

Prevention
The causes of vocal process granulomas are quite varied, and as such prevention must target the individual causes. Education on lifestyle factors such as habitual vocal abuse and habits that may aggravate gastro-esophageal reflux should be implemented to lower risk, and those who use their voice professionally should use vocal hygiene techniques to ensure safe voice use. Vocal hygiene may include increasing water intake, eliminating external irritants such as smoking or airborne chemicals, controlling loudness, and balancing periods of increased vocal use with periods of rest. Since intubation can also cause vocal process granulomas, proper muscle relaxing medications should be used before insertion and removal of tubes, that smaller tubes are used and with proper lubrication, and that patient movement is controlled during intubation.

Outcomes and Prognosis
As the masses of granular tissue are most often benign, prognosis is generally positive. However, due to the variety of treatment options and lifestyle factors, outcomes of individual treatments and form of management vary. A high proportion of contact granulomas are present in patients with concurrent gastroesophageal reflux, and so treatment of the reflux is imperative. Those caused by intubation trauma are less likely to recur .The most common treatment is voice therapy by a speech-language pathologist, and this therapy is enough for many patients. Surgical solutions are sometimes used, however rates of recurrence are higher. Most recent research suggests that surgical options should only be explored once treatment of reflux with or without voice therapy has been introduced.