Vocal Fold Granuloma

A vocal fold or vocal process granuloma is a cluster of abnormal and inflamed tissues that occurs on the back part of the vocal cords. Sometimes, they’re thought to be caused by an overuse of the voice.

Symptoms can include voice weakness or fatigue, a tickle in the throat, cough, and hoarseness. You may also experience the need to clear your throat or the sensation of something being caught in the throat, the “frog in my throat” feeling.

A granuloma may result from the placement of an endotracheal tube from surgery or because of gastroesophageal reflux disease (GERD). This is a condition where acid from the stomach flows backward up the esophagus (the food tube). This acid can damage the vocal process and create granulomas. The reflux occurs when the muscles in the lower part of the esophagus fail, allowing stomach acid and contents to reverse course.

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What is GERD (Gastrointestinal Reflux Disease)?

Symptoms of GERD include heartburn and acid regurgitation, or the feeling of acid in the esophagus. You may also experience trouble swallowing or acid laryngitis. There is no age or gender more likely to suffer from GERD, and about half of all people in the United States experience GERD at least once a month. When you’re experiencing these symptoms more frequently, you might want to discuss it with your doctor.

Risk factors for GERD include obesity, smoking, and a precancerous condition called Barrett’s esophagus. But there are many other variables that might also put you at risk for GERD, like stomach ulcers, diabetes, lymphomas (cancer), and certain medications like nonsteroidal anti-inflammatory drugs (NSAIDs).

Your doctor may use a long, thin scope either through your nose or mouth to examine the vocal process and upper esophagus for damage due to acid reflux. He or she may also take a biopsy, a small sample of tissue for examination.

Treatment

Treatment for vocal process granuloma includes treatments of the underlying cause. If GERD is the cause, there are some lifestyle changes you can do to help your situation. This may mean a reduction in caffeine and foods like chocolate, garlic, onions, and alcohol. Eat foods low in fat like fish, chicken, and skim dairy products.

Don’t eat meals before a nap or snack for 2 hours before bedtime. Sleep on your left side rather than your right or sleep with your head lifted up to help keep acids in the stomach.

Medications such as proton pump inhibitors (PPIs) or H2 blockers can be used to reduce the amount of acid your stomach produces. But, side effects from long-term use are still being studied. Your doctor may also choose to perform surgery on the affected vocal process.

Your prognosis for a vocal process granuloma is quite good, providing you seek medical treatment and follow your doctor’s instructions.

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