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Highlights
In Brief
Vocal fold granulomas are non-cancerous growths on the 2 vocal folds comprised of cells and substances often found in sites of inflammation (inflammatory tissue) and reflect a response to irritation or injury. They are usually found near the back portion of the vocal folds over the vocal process of the arytenoid cartilages at the site of contact during vocal fold closure. They often appear pale or sometimes red. (For more information, see Anatomy and Physiology of Voice Production.)
Other Terms Used
contact granuloma, vocal process granuloma
A Note About the Term 'Granuloma'
In the strictest sense, the term 'granuloma' refers to a particular composition of granulation tissue defined by microscopic examination of contents. With this strict definition, vocal fold granulomas are not always made of granulation tissue – however, the "loose" use of the term is accepted.
Common Causes
The common causes of vocal fold granuloma include:
- irritation from a breathing tube (endotracheal intubation trauma);
- irritation from excessive vocal fold contact with improper or excess voice use;
- backflow of acidic stomach fluids to the voice box or laryngopharyngeal reflux. (For more information, see Reflux Laryngitis.)
Sometimes, a vocal fold granuloma may be caused by all three – or any combination.
Identification of Cause Important for Successful Treatment
The first-line treatment plan for vocal fold granulomas should remove or reduce the condition or conditions that caused the irritation to the vocal folds in the first place, such as:
- anti-reflux medicine if vocal fold granuloma due to backflow of stomach fluids to the voice box area,
- voice therapy if vocal fold granuloma due to excessive or improper voice use, or
- elimination of foreign body.
If more than one cause contributes to vocal fold granuloma, treatment needs to address all of the causes to be successful and to achieve long-term success.
Role of Surgery in Granuloma Treatment
Surgery should only be used to treat granulomas that do not respond to first-line treatments of the cause, or if underlying laryngeal cancer is also suspected.
Key to Long-Term Control
If the main cause is not properly identified and treated, vocal fold granulomas often recur even after surgical removal. Long-term control of a vocal fold granuloma requires follow-up by the patient and proper management of the cause or causes of vocal fold irritation.
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