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Examples of vocal cord granulomas. The upper picture demonstrates large obstructing granulomas. These granulomas may warrant removal because of their size. |
A granuloma is a particular type a laryngeal lesion that represents the body's response to chronic irritation or trauma. They occur most commonly in the back portion of the voice box. Occasionally they may occur elsewhere. Granulomas may form on one side or both sides of the voice box, and grow to very large sizes, occasionally causing obstruction of normal breathing.
Patients with granulomas may complain of hoarseness, chronic throat clearing, throat pain, cough (occasionally blood-tinged), and a sense of a "lump in the throat." Diagnosis is made with either flexible fiberoptic laryngoscopy or rigid transoral laryngoscopy. Further studies that may be ordered to evaluate the cause of the granuloma may include a voice evaluation (which may give insight into abnormal speaking patterns that perpetuate the granulomas), and a pH study. Treatment depends on cause, which is usually a combination of abnormal speaking technique and LPR. In typical cases, patients are given speech therapy along with medical treatment of LPR. Granulomas are often slow to regress, and this therapy may take several months to eliminate the problem. If this therapy is unsuccessful, other alternatives include botulinum toxin injection of the vocal cord or surgical removal of the lesion. Recurrent granulomas may need aggressive anti-reflux therapy including Nissen fundoplication.
