Vocal Cord Granuloma

Overview

A vocal cord granuloma is a benign (noncancerous) growth that develops at the back part of the voice box, typically over the firm cartilage area where the vocal cords attach. It forms as a result of irritation and inflammation, as the tissue tries to heal repeated injury in this sensitive spot.

Granulomas are often linked to acid reflux, irritation from a breathing tube during surgery (intubation), and forceful voice use or chronic throat clearing. They differ from nodules and polyps, which form along the vibrating edge of the vocal cords. Vocal cord granulomas are benign, but persistent throat or voice symptoms should be evaluated, since treatment usually focuses on removing the underlying irritant.

Because the back of the voice box takes much of the stress when the vocal cords come together forcefully and is exposed to anything that refluxes up from the stomach, this area is prone to irritation. A granuloma represents the tissue's attempt to heal repeated injury, but ongoing irritation keeps it inflamed and prevents healing. This is why simply removing a granuloma without addressing the cause often leads to it coming back, and why treatment emphasizes controlling reflux and voice strain.

Symptoms

Symptoms can vary, and some small granulomas cause few problems. When present, symptoms may include:

• Hoarseness or a rough voice
• A sensation of a lump in the throat
• Throat discomfort or pain, sometimes felt with talking
• Frequent throat clearing or a chronic cough
• Vocal fatigue or effortful voicing
• Rarely, the feeling of something in the throat when swallowing

Symptoms may overlap with reflux-related throat irritation, which is a common contributing factor.

Causes

Vocal cord granulomas form from repeated irritation and inflammation at the back of the voice box. Common causes include:

• Acid reflux: GERD or reflux reaching the throat can irritate the area and is a frequent contributor.
• Intubation: Pressure or injury from a breathing tube placed during surgery or in intensive care.
• Vocal trauma: Forceful or excessive voice use, hard glottal attacks, and chronic throat clearing or coughing.

Often more than one factor is involved, and ongoing irritation keeps the granuloma from healing.

Risk Factors

• Acid reflux or laryngopharyngeal reflux
• Recent intubation or surgery requiring a breathing tube
• Heavy or forceful voice use
• Chronic cough or habitual throat clearing
• Smoking and throat irritants

Diagnosis

An ENT specialist diagnoses a vocal cord granuloma by examining the voice box. Evaluation may include:

• Laryngoscopy: Viewing the back of the voice box with a small camera to identify the granuloma.
• Videostroboscopy: Assessing vocal cord vibration and the lesion.
• Reflux assessment: Looking for signs of acid reflux as a contributing factor.
• Biopsy: Occasionally done if there is any uncertainty about the diagnosis.

Treatment

Treatment focuses on removing the underlying irritation so the granuloma can heal. Many granulomas improve without surgery. Options include:

• Reflux treatment: Acid-reducing medicines and dietary measures when reflux is contributing.
• Voice therapy: Working with a speech-language pathologist to reduce strain, eliminate hard voicing, and stop throat clearing.
• Treating cough and irritants: Managing chronic cough and avoiding smoking and other irritants.
• Surgery or injections: For granulomas that do not respond to conservative care, are very large, or affect breathing, a procedure to remove the granuloma may be considered, though they can recur if the cause is not addressed.

Because granulomas tend to come back when irritation persists, controlling the cause is the key to lasting improvement. Treatment often takes patience, as it can take weeks to months for a granuloma to shrink once the irritation is reduced. Working with both an ENT specialist and a speech-language pathologist, and addressing reflux at the same time, gives the best chance of lasting relief.

Prevention

• Manage acid reflux with treatment and lifestyle measures
• Avoid forceful voice use and frequent throat clearing
• Use good vocal technique and stay hydrated
• Avoid smoking and throat irritants
• Treat chronic cough at its source

When to See a Doctor

See a doctor or ENT specialist if you have:

• Hoarseness, throat discomfort, or a lump-in-the-throat feeling lasting more than two to three weeks
• Persistent throat clearing or cough with voice changes
• Voice problems that do not improve

Persistent throat and voice symptoms should be evaluated to confirm the cause and rule out other conditions of the voice box.

Related Topics

Frequently Asked Questions

References

1. American Academy of Otolaryngology–Head and Neck Surgery. Hoarseness.
2. National Institute on Deafness and Other Communication Disorders (NIDCD). Hoarseness.
3. MedlinePlus, U.S. National Library of Medicine. Vocal cord disorders.