Laryngeal granulomas are benign growths that develop on the vocal cords or within the larynx, commonly known as the voice box. These benign lesions are a frequent source of voice problems, leading individuals to seek medical attention for changes in their vocal quality or throat discomfort. Understanding the nature of these growths helps in addressing their impact on vocal health.
What is a Laryngeal Granuloma
A laryngeal granuloma is an inflammatory lesion, a reaction to irritation or trauma, not a tumor. These lesions typically form on the vocal process of the arytenoid cartilage, located at the back of the vocal cords. This area is particularly susceptible to irritation due to its thin tissue layer cushioning the underlying cartilage.
A granuloma usually appears as a reddish or pale mound of tissue raised from the surrounding mucous membrane. It can range in size, presenting as a smooth, spherical mass or having a cleft from repeated contact with the opposite vocal fold. Granulomas are an exuberant healing response, where the body creates excess tissue to repair damage.
Recognizing the Signs and Causes
Patients with laryngeal granulomas experience symptoms affecting their voice and throat. Hoarseness, also known as dysphonia, is a common complaint, sometimes accompanied by changes in voice pitch or voice breaks. Individuals may also report vocal fatigue, a feeling of something stuck in the throat (globus sensation), or discomfort and pain in the throat that can sometimes radiate to the ear. Chronic coughing or frequent throat clearing are also common symptoms, which can paradoxically worsen the granuloma by increasing irritation.
Laryngeal granulomas are generally linked to chronic irritation or trauma to the larynx. One cause is laryngopharyngeal reflux (LPR), where stomach acid travels up into the throat and irritates the delicate tissues of the voice box. Another contributing factor is vocal abuse or misuse, including behaviors like excessive coughing, frequent throat clearing, shouting, or forceful singing. These actions cause repeated impact and friction on the vocal cords, leading to tissue damage and granuloma formation. Additionally, trauma from endotracheal intubation during surgery can lead to granuloma development in the days or weeks following the procedure.
Diagnosis and Treatment Approaches
Diagnosing a laryngeal granuloma involves a visual examination of the larynx. A laryngologist performs a laryngoscopy, which can be flexible or rigid, to view the vocal cords and surrounding structures. During this procedure, the doctor looks for the characteristic reddish or pale lesion on the vocal process of the arytenoid cartilage. The growth’s location and appearance often provide enough information for a diagnosis, though a biopsy may sometimes be performed to rule out other conditions.
Treatment strategies for laryngeal granulomas begin with conservative measures, focusing on addressing the underlying causes. Voice therapy helps patients correct vocal misuse and develop healthier speaking habits. For those with acid reflux, medication like proton pump inhibitors (PPIs) is prescribed to reduce stomach acid production, often for several months, alongside dietary changes to minimize reflux symptoms. Lifestyle modifications, such as avoiding irritants like smoking and excessive throat clearing, are also recommended. Surgical removal may be considered if conservative treatments are unsuccessful, if the granuloma is large and obstructs breathing, or if there is a need to definitively rule out other conditions. While surgery provides immediate relief, it carries a risk of recurrence, especially if underlying causes are not adequately managed.
Recovery and Preventing Recurrence
Following treatment for a laryngeal granuloma, consistent adherence to therapeutic recommendations is important for recovery and preventing recurrence. If acid reflux was a contributing factor, continued use of prescribed medications and maintaining dietary adjustments are necessary. Patients are advised to practice voice rest and gradually reintroduce vocal activities under the guidance of a voice therapist to prevent further irritation.
The potential for recurrence of laryngeal granulomas is a concern, with some studies reporting recurrence rates after surgery as high as 38.7% for contact granulomas. This highlights the importance of addressing the root causes rather than solely removing the lesion. To prevent recurrence, individuals should continue reflux management, adopt proper vocal hygiene practices, and avoid habits like chronic throat clearing and excessive coughing. Regular follow-up appointments with a voice specialist help monitor the healing process and adjust treatment as needed, providing a proactive approach to maintaining vocal health.