Vocal Cord Granuloma (Contact Granuloma)

Where granulomas form and why

Each vocal cord attaches at the back of the larynx to a small cartilage called the arytenoid. The vocal process of the arytenoid is covered by a thin lining over cartilage. When this lining is repeatedly bumped, rubbed or exposed to acid, it ulcerates. The body's healing response produces excess granulation tissue, forming a granuloma.

Main causes

• Reflux: stomach acid and enzymes reaching the throat (laryngopharyngeal reflux, linked to GERD), often without heartburn
• Vocal behaviors: chronic throat clearing, harsh coughing, and speaking loudly at a forced low pitch, which slams the back of the vocal cords together
• Intubation: pressure from a breathing tube during surgery or intensive care
• Smoking and other irritants

Contact granulomas from voice use and reflux are more common in men. Intubation granulomas are more common in women, possibly because of a smaller larynx.

Symptoms

• throat pain or discomfort, usually on one side
• pain spreading to the ear (earache) on the same side
• a feeling of a lump in the throat (globus)
• frequent throat clearing or a chronic cough
• mild hoarseness or voice fatigue (often the voice is only slightly affected)
• rarely, breathing difficulty if a granuloma is very large

Diagnosis

An ENT specialist examines the larynx with a flexible or rigid camera (laryngoscopy), often with stroboscopy to assess vocal cord vibration. A granuloma typically appears as a smooth, rounded, pale or reddish lump on the back third of one or both vocal cords.

A biopsy may be recommended if the lump looks unusual, does not respond to treatment, or the person has risk factors for laryngeal cancer such as smoking and heavy drinking.

How it differs from other vocal cord lesions

Treatment

Reflux treatment

• proton pump inhibitors such as omeprazole, often twice daily, for at least 2 to 3 months
• lifestyle changes: avoid eating within 3 hours of bedtime, raise the head of the bed, limit alcohol, caffeine and fatty or spicy foods, lose weight if needed, and stop smoking

Voice therapy

A speech-language pathologist teaches:

• how to stop throat clearing (for example, sipping water or swallowing instead)
• gentle voice production at a natural pitch
• cough control strategies
• vocal hygiene: hydration and voice rest when needed

Other treatments

• inhaled or injected steroids in some cases
• botulinum toxin injections into the vocal cord muscles to reduce the forceful contact while the granuloma heals, for recurrent granulomas
• surgical removal for granulomas that block the airway, do not respond to medical treatment, or need biopsy. Recurrence after surgery is common unless the underlying cause is treated.

Intubation granulomas often resolve on their own within weeks to months.

Outlook

Most granulomas shrink or disappear with reflux treatment and voice therapy, usually over 3 to 6 months, sometimes longer. They can return if reflux or throat-clearing habits continue.

Frequently asked questions

What is a vocal cord granuloma?

A vocal cord granuloma is a benign lump of inflamed healing tissue at the back of the vocal cords. It forms after repeated irritation from reflux, throat clearing, forceful talking or a breathing tube. It is not cancer.

What are the symptoms of a vocal cord granuloma?

Common symptoms include throat pain on one side, pain spreading to the ear, a feeling of a lump in the throat, frequent throat clearing and mild hoarseness. Large granulomas can rarely affect breathing.

How is a vocal cord granuloma treated?

Treatment usually combines acid-reducing medicine, reflux lifestyle changes and voice therapy to stop throat clearing and forceful speaking. Steroids, botulinum toxin injections or surgery are used when granulomas persist or recur.

Can a vocal cord granuloma go away on its own?

Some, especially those caused by a breathing tube, resolve without treatment within weeks to months. Granulomas caused by reflux and voice habits usually need treatment of those causes to heal and to prevent recurrence.

Is a vocal cord granuloma cancer?

No. Vocal cord granulomas are benign. However, any persistent lump on the vocal cords should be examined by an ENT specialist, and a biopsy may be taken if the appearance is unusual or there are cancer risk factors.