 The injection of botulinum neurotoxin A, or Botox, to treat contact granulomas is considered a more extreme approach, and is generally only pursued when the case has been resistant to other treatments.In this approach, Botox is injected into the thyroarytenoid muscle (unilaterally or bilaterally), targeting a reduction in the contact forces of the arytenoids.Surgery

When all other medical and behavioural treatments have been attempted, surgical removal of the contact granuloma is possible as a last resort option.