Symptoms of Vocal Fold Granuloma

Key Glossary Terms

Vocal Fold Granuloma
Pale, sometimes red, mass on vocal folds resulting from irritation; contains inflammatory cells, new blood vessels; usually found over arytenoid cartilages at the site of contact during vocal fold closure

Vocal Folds
Also known as vocal cords; a pair of muscular ligaments in the voice box (larynx) which vibrate to produce sound

Arytenoid Cartilages
Pair of pyramid-shaped cartilages to which the vocal folds are attached in the back of the voice box; spaced well apart for normal breathing; come together for sound production

Glossary

Patients with vocal fold granuloma usually complain of (A) problems with their voice, and/or (B) some form of throat discomfort.

Abnormal Event	Patient Complaints
Granuloma interferes with vocal fold function (adequate closure and/or vibration) and impairs sound production	Hoarse or rough voice Breathy or airy voice Voice sounds lower than usual low (pitch)
Patient "works harder" to overcome voice difficulties resulting from granuloma	Need to work harder than usual to speak, sing, or do voice tasks (effortful phonation) Voice tires with voice use (vocal fatigue)
Granuloma causes irritation of arytenoid cartilage(s)	Pain on speaking (odynophonia)

Although patients with vocal fold granuloma can have one, more than one, or all of these complaints, these voice complaints are also found in other voice disorders – hence medical evaluation is necessary to identify the cause or causes.

Key Information

Worse With Increase in Size

Patient voice complaints (symptoms) typically worsen over time as a granuloma grows in size and has a greater effect on vocal fold closure (breathiness) and vibration (hoarseness).

"Slow Paced" Time Course Usual

Worsening of voice complaints is typically gradual or "slow-paced." Often patients are unaware of the problem until someone else notices the change.

Patients with vocal fold granuloma also complain of:

• "Lump in the throat" feeling (globus sensation), often more pronounced when swallowing
• Tickle in the throat
• Throat pain or sore throat
• Pain that seems to be in the ear (otalgia)
• Pain or irritation when swallowing
• Dry or non-productive cough

These symptoms, which are often noticed while swallowing, can also occur while speaking or eating.

Key Information

Avoiding a "Vicious Cycle"

• Frequent coughing or throat clearing can lead to a new vocal fold granuloma or delay the healing of an existing one.
• Coughing and throat clearing may worsen the "lump in the throat" feeling or the tickle in the throat.

Vocal fold granulomas can continue to grow if left untreated. Although quite rare, vocal fold granulomas can become large enough to block the flow of air through the voice box causing patients to experience:

• Shortness of breath at rest or with exertion
• Noisy breathing (stridor)

Red Flag

• Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway.
• Stridor is a sign of difficulty passing air.
• Any breathing difficulty needs immediate medical attention.