What is Vocal Cord Granuloma?

Vocal cord granuloma is a usually benign tissue reaction that occurs on the vocal cords. These formations typically develop on the posterior part of the vocal cords. They often arise due to mechanical trauma, chronic irritation, or conditions like gastroesophageal reflux. It is more common in men than in women.

How Does a Granuloma Form?

The vocal cords are delicate structures. The following conditions particularly predispose to the formation of vocal cord granulomas:

• Prolonged and forceful voice use
• Endotracheal intubation (placement of a tube into the throat during surgery)
• Gastroesophageal reflux disease (GERD)
• Chronic coughing or throat clearing habit
• Smoking

These factors apply continuous microscopic trauma to the vocal cords, and during the healing process, an abnormal tissue reaction develops, leading to granuloma formation.

What Are the Symptoms?

Vocal cord granulomas may sometimes be asymptomatic. However, they often cause the following symptoms:

• Hoarseness
• Sensation of stinging or burning in the throat
• Feeling of a foreign body in the throat
• Speaking with effort
• Pain during speech

How is the Diagnosis Made?

Diagnosis is usually made by an ear, nose, and throat (ENT) specialist through an endoscopic examination. The vocal cords are visualized in detail using fiberoptic or rigid endoscopy. Granulomas appear as characteristic raised and reddened lesions.

What Are the Treatment Methods?

The treatment of vocal cord granuloma starts by addressing the underlying cause. Treatment options include:

Medical Treatment

• Acid-suppressive medications for reflux (proton pump inhibitors)
• Elimination of habits causing irritation

Voice Therapy

• Proper voice use is taught with the guidance of a speech therapist.
• Incorrect phonation techniques are corrected.

Surgical Intervention

• In cases resistant to medication and therapy, granuloma is removed via endoscopic surgery.
• Post-surgical voice rest, medical treatment, and voice therapy should be applied.

When is Surgery Necessary?

Surgery is generally preferred in the following situations:

• If the granuloma is large enough to cause breathing difficulties
• If it severely affects voice quality
• If there is no improvement after long-term medical treatment and voice therapy
• If the granuloma recurs frequently
• If a biopsy is needed for diagnostic purposes (in case of suspected cancer)

How is the Surgery Performed?

Vocal cord granuloma surgery is performed using an endoscopic method, entering through the mouth under general anesthesia. No external incisions are made.

The surgical steps are as follows:

• The patient is put under general anesthesia.
• The vocal cords are visualized with a special endoscope placed through the mouth.
• Under microscopic magnification, the granuloma is carefully removed without damaging surrounding tissues.
• If necessary, local steroids or botox may be applied to the area.
• The procedure typically lasts 30–45 minutes.

Postoperative Process

Points to consider after surgery include:

• Voice rest: The patient should not speak or should speak very minimally for the first 5–7 days.
• Reflux treatment should continue (if present).
• Traumatic behaviors such as smoking, throat clearing, and shouting should be avoided.
• Follow-up visits should not be missed, and recommended voice therapy should be initiated.

Does Granuloma Recur?

Unfortunately, in some patients, the granuloma may recur after surgery. If the underlying causes (such as reflux, improper voice use, or smoking) persist, the risk of recurrence increases.

Conclusion

Vocal cord granuloma is mostly a benign condition but can seriously affect swallowing or voice quality. Early diagnosis and comprehensive treatment ensure a high success rate. Take good care of your voice, and consult a specialist without delay if you experience any symptoms.