A Granuloma is a growth that results from the body’s response to chronic irritation or trauma. Granulomas are non-cancerous (benign) and are commonly seen in the back portion of the vocal fold. These growths may form on one side or both sides of the larynx, and may grow into very large sizes, occasionally causing obstruction of normal breathing.
The chronic irritation leading to a vocal fold Granuloma may simply result from the impact of the vocal fold with the opposite vocal fold when the folds come together during regular speaking. This occurs even more forcefully during loud speaking, singing, throat-clearing, and coughing.
The vocal folds can also become irritated from the breathing tube placement through the vocal folds during general anesthesia. This irritation may result in a Granuloma (Intubation Granuloma), which often grows in the days and weeks after the intubation.
In addition, Laryngopharyngeal Reflux, an important source of irritation in the larynx, is also a common cause of vocal fold Granulomas.
Hoarseness, chronic throat clearing, throat pain, coughing (occasionally blood-tinged), and a foreign body sensation (sense of a “lump in the throat”) are common symptoms. Granulomas are one of the few vocal fold growths that can be painful.
Treatment depends on the cause of the Granuloma and is tailored to correct or prevent the irritation that resulted in the growth. Often, control of Laryngopharyngeal Reflux and voice therapy results in slow regress of the growth. Voice therapy is aimed at correcting behaviors that cause vocal fold irritation, such as habitual loud-talking or throat clearing.
When reflux control and voice therapy fail to resolve the Granuloma, alternative treatments including Botulinum toxin injection of the vocal folds or surgical removal of the growth are considered. The goal of Botulinum toxin injection is to weaken the vocal fold and decrease movement, thus reducing the irritation. Surgery is generally the last treatment of choice and is used in cases where very large Granulomas are obstructing the airway or taking a long time to resolve. Surgery without treatment of the underlying factors that caused the Granuloma often results in recurrence of the Granuloma.