What the HECK is a GRANULOMA?

August 23, 2021

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What the HECK is a GRANULOMA?!

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By definition, a granuloma is a benign (non-cancerous) growth resulting from IRRITATION or TRAUMA, normally found at the back of the vocal folds (VFs) over the vocal process(es). Since there is less overlying soft tissue for cushioning at this spot, this area is more susceptible to trauma from impact (often related to the opposite VF/vocal process, and when the two sides come together). As we know, this occurs during talking, but more force (and possible trauma) is often the case during coughing, singing, yelling, talking at a loud volume, and/or throat clearing. In addition, IRRITATION to this region can also be caused by laryngopharyngeal reflux and/or intubation (during surgeries). 

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Symptoms reported most often by those people with granulomas may include hoarseness, strain/effort during voice production, pain, voice/pitch breaks, the sound of a “pressed voice”, the perception of “something” in the throat (globus sensation), and/or the “need” to clear the throat or produce a dry/habitual cough.  When constant (further) trauma to the granuloma occurs (via throat clearing/coughing OR use of a “pressed” or consistently loud voice), MORE irritation will occur and the granuloma can increase in size. If the granuloma is very large, it can reduce the chances of full VF closure (which can further impair vocal quality: breathiness, more "work" to produce voice, more difficult to achieve louder volume).

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Granulomas can be reduced, controlled, &/or eliminated via the use of aggressive reflux management (anti-acid meds, dietary and lifestyle modifications, etc.), voice therapy (to reduce the overcompensatory behavioral and voice patterns that contribute to further trauma/irritation), and/or surgery (especially for very large granulomas that may take an extended period of time to resolve). If surgery is decided, the best recommendation is surgery WITH treatment (reflux management, voice therapy) to prevent recurrence. 

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I did a stroboscopy on this patient a few weeks back and thought this granuloma was SO AWESOME that I had to do a post about it.

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