[1][2][9] These symptoms often provoke observable clinical signs such as frequent coughing, throat-clearing, and hoarseness accompanied by dysphonia, reduced voice quality and restricted vocal range.

[19] Age-based calculations of appropriately sized intubation tubes are conducted in accordance with the Khine formula, which are based on internal diameters.

[22] According to PALS (2010) guidelines, the use of length-based resuscitation tapes has proven to be more accurate than age-based estimates of endotracheal intubation tubes.

[23] However, hyperinflation of the cuff places excessive pressure on the tracheal wall, causing trauma or ischaemia to nearby tissue and hence increasing the risk of granuloma formation.

[2][27] Intubation granulomas are most commonly presented in the form of red or pale spherical lesions in the subglottis of the larynx and may be defined as protruding, inflamed fibrovascular tissue.

[30] In other cases where granulomas are found in areas not on the posterior larynx, such tissue injury can also be accounted for by accidental lacerations from the tip of the endotracheal tube or its introducer.

[28] A thin cannula and catheter can be further used in place of traditional small-diameter endotracheal tubes during surgery, which enables precise visualisation of anatomical configurations within the surgical field.

[34] However, due to the side effects of steroidal interventions, antibiotics have to be prescribed alongside to reduce pain and inflammation in the region of the target granuloma.

[7][8] Intralaryngeal BOTOX injections bind specifically and non-competitively to presynaptic cholinergic neuron membranes at neuromuscular junctions which induce zinc-dependent cleavage of proteins involved in neuroexocytosis.

[38] The breakdown of neuroexocytosis proteins block acetylcholine secretions which inhibit hypertonicity, strengthen antagonist muscles and restore the balance of forces.

[39][40] Oral zinc sulfate treatments are advantageous due to their ability to preserve the anatomical and functional integrity of the vocal cords.

[8] Similarly, this form of therapy can achieve quick relief of granuloma-related symptoms whilst avoiding invasive surgery and toxic drug effects.

[4] Compared to adults, newborns and young children possess a higher, more anterior larynx, a larger and stiffer epiglottis as well as a more fragile laryngotracheal mucosa, making them more vulnerable to traumatic damage by prolonged tracheal intubation.

[2][41] Gender Females were found to be at greater risk of intubation granulomas as they tend to have a narrower glottis, lower glottic proportion and a thinner arytenoid mucochondrium.

[42] Anatomical characteristics Congenital and/or acquired abnormalities of the larynx - laryngeal webs, bands, cysts and tumours - are predisposing risk factors of intubation granuloma.