Vocal Cord Granuloma

What is vocal cord granuloma?

A vocal cord granuloma usually forms behind the vocal cords, on the cartilaginous part where the vocal cords are attached. It is a benign growth, so there is no evidence that it can develop into cancer. Causes may include throat reflux (laryngopharyngeal reflux), placement of a throat tube during general anaesthesia for a previous operation (intubation), and abuse and misuse of the voice (voice abuse; phonotrauma). Frequent and forceful coughing, habitual throat clearing and secondary hyperfunctional voice use may also contribute to problems with vocal cord closure.

What are the symptoms of vocal cord granuloma?

People with vocal cord granuloma complain of changes in voice quality. The voice may sound hoarse, and large granulomas can affect vocal cord closure, causing a faint voice, a voice that sounds two-tone, or a broken voice. Another problem is the sensation of having something stuck in the throat or feeling as if there is something in the throat. This can lead to the need to clear the throat and cough, potentially causing the granuloma to grow. Some people may also have sudden pain when swallowing or coughing, or pain that occurs after a period of talking. This pain may occur around the vocal cords or radiate into the ear.

How does vocal cord granuloma occur?

The posterior region, where the vocal cord cartilage is located, is where the strongest movement of the vocal cords takes place. This area has a very thin protective lining over the vocal cords, making it prone to injury. Granuloma is actually the healing process of the injured area. It takes place in four stages: bleeding, inflammation, proliferation and remodelling. It can appear as a very small sunken wound (ulcer, vocal cord ulcer) or it can be large enough to narrow the airway.

How is it diagnosed?

The diagnosis can be easily made using endoscopic examination methods of the vocal cords, such as videolaryngostroboscopy or flexible fibreoptic examination. Acoustic analysis methods can be used to understand how much it affects voice quality.

How is granuloma treated and does it recur?

The risk of recurrence of granuloma is very high. After surgical removal, this rate can be up to 90%, so it is not appropriate to rely solely on surgical intervention as the primary option. The main components of treatment are management of throat reflux and voice therapy. Surgical removal not only confirms the pathological diagnosis but also rapidly improves voice quality. However, additional medical interventions (vocal cord medication injections) at the time of surgery, together with reflux management and voice therapy, will support the persistence of success.