Vocal fold granuloma or vocal process granuloma is a benign growth that originates in the posterior portion of the voice box over the cartilaginous attachment (vocal process) of the back portion of the vocal fold. This area is prone to irritation or trauma, sometimes from a breathing tube placed during general anesthesia for ventilation of the anaesthetized patient. Sometimes the back portion of the vocal fold is irritated by acid reflux or other irritants and made worse by throat clearing, talking loudly, coughing, and/or singing. Granulomas may cause a sensation that something is “stuck” in the throat. Often this sensation will lead to further throat clearing causing additional inflammation. Granulomas usually form and continue to increase in size because of this vicious cycle. They can be very stubborn and prone to recurrence.

Although granulomas are not pre- cancerous or cancerous, they may require microscopic laryngeal surgery. Surgery is done in many cases in order to exclude vocal cancers or to reduce symptoms from large granulomas. Also, granulomas that do not seem to be responding to medical therapy are sometimes removed. Almost always surgery is accompanied by medical therapy and voice therapy. It is clear that the other aspects of the treatment of granuloma that are just as important as surgery. Aggressive control of acid reflux, modification of certain voice use patterns, eliminating throat clearing, and changing voice misuse are key to long-term success.