Vocal Fold Granuloma: Highlights

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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

Vocal fold granulomas are non-cancerous growths on the two vocal folds comprised of cells and substances often found in sites of inflammation (inflammatory tissue) and reflect a response to irritation or injury. The granulomas 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 & Physiology of Voice Production.)

Contact granuloma, vocal process 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.

The common causes of vocal fold granuloma include:

1. Irritation from a breathing tube (endotracheal intubation trauma)
2. Irritation from excessive vocal fold contact with improper or excessive voice use
3. Backflow of acidic stomach fluids to the voice box (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. Options include:

1. Anti-reflux medicine, if vocal fold granuloma due to backflow of stomach fluids to the voice box area
2. Voice therapy, if vocal fold granuloma due to excessive or improper voice use
3. Elimination of foreign body

If more than one cause contributes to vocal fold granuloma, treatment needs to address all the causes to be successful and achieve long-term success.

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.

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.

Advisory Note