Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 9
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Tachibana, Tomoyasu Orita, Yorihisa Makino, Takuma Ogawara, Yuya Matsuyama, Yuko Shimizu, Aiko Nakada, Michihiro Marunaka, Hidenori and Nishizaki, Kazunori 2016. A Clinical Study on 64 Cases of Laryngeal Granuloma. Nippon Jibiinkoka Gakkai Kaiho, Vol. 119, Issue. 6, p. 860.

    Hu, Hao-Chun Hung, Yi-Ting Lin, Shu-Yi and Chang, Shyue-Yih 2015. Office-based Autologous Fat Injection Laryngoplasty for Vocal Process Granuloma. Journal of Voice,

    Ma, Lijing Xiao, Yang Ye, Jingying Yang, Qingwen and Wang, Jun 2015. Analysis of therapeutic methods for treating vocal process granulomas. Acta Oto-Laryngologica, Vol. 135, Issue. 3, p. 277.

    Yılmaz, Taner Kayahan, Bahar Günaydın, Rıza Önder Kuşçu, Oğuz and Sözen, Tevfik 2015. Botulinum Toxin A for Treatment of Contact Granuloma. Journal of Voice,

    Wang, Hsing-Won Chen, Mei-Chien and Chao, Pin-Zhir 2014. Bilateral Large Postintubation Vocal Granulomas. Journal of Experimental & Clinical Medicine, Vol. 6, Issue. 1, p. 29.

    Hong-Gang, Duan He-Juan, Jin Chun-Quan, Zheng and Guo-Kang, Fan 2013. Surgery and proton pump inhibitors for treatment of vocal process granulomas. European Archives of Oto-Rhino-Laryngology, Vol. 270, Issue. 11, p. 2921.

    Sun, Guang-bin Sun, Na Tang, Hai-hong Zhu, Qiu-bei Wen, Wu and Zheng, Hong-liang 2012. Zinc sulfate therapy of vocal process granuloma. European Archives of Oto-Rhino-Laryngology, Vol. 269, Issue. 9, p. 2087.

    Keefe, M.A. 2009. An endoscopic grading system for vocal process granuloma. Yearbook of Otolaryngology-Head and Neck Surgery, Vol. 2009, p. 54.

    Wang, Cheng-Ping Ko, Jenq-Yuh Wang, Yung-Han Hu, Ya-Ling and Hsiao, Tzu-Yu 2009. Vocal process granuloma – A result of long-term observation in 53 patients. Oral Oncology, Vol. 45, Issue. 9, p. 821.


An endoscopic grading system for vocal process granuloma

  • D G Farwell (a1), P C Belafsky (a1) and C J Rees (a1)
  • DOI:
  • Published online: 01 March 2008

A reliable grading system allows the clinician to classify disease severity, monitor progress and evaluate treatment efficacy. There is no currently accepted grading system for vocal process granuloma of the larynx.


To evaluate the reliability of a new grading system for vocal process granuloma.


All vocal process granuloma images from a digital laryngeal image library were abstracted. Granulomas were graded on a one to four system, as follows: grade one, sessile, non-ulcerative granuloma limited to vocal process; grade two, pedunculated or ulcerated granuloma limited to vocal process; grade three, granuloma extending past vocal process but not crossing midline of airway in fully abducted position; and grade four, granuloma extending past vocal process and past the midline of the airway in the fully abducted position. The granulomas were additionally graded A if unilateral and B if bilateral. Two laryngologists and two otolaryngology residents rated the granulomas on two separate occasions. Intra- and inter-observer reliability was evaluated with the kappa (κ) test statistic.


Thirty-five vocal process granulomas were identified. The percentage intra-observer agreement for the two laryngologists was 97 and 100 per cent (κ = 0.94 and 1.00, respectively). The percentage inter-observer agreement between the two laryngologists was 91 per cent (κ = 0.83). The percentage intra-observer agreement for the two residents was 89 and 91 per cent (κ = 0.83 and 0.77, respectively). The percentage inter-observer agreement between the two residents was 83 per cent (κ = 0.67).


The proposed grading system for vocal process granuloma displayed excellent intra- and inter-observer reliability among residents and experienced laryngologists.

Corresponding author
Address for correspondence: Dr D Gregory Farwell, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA. E-mail:
Hide All

Presented at the American Academy of Otolaryngology Annual Meeting, September, 20 2006, Toronto, Ontario, Canada.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1T Shin , H Watanabe , M Oda , T Umezaki , I Nahm . Contact granulomas of the larynx. Eur Arch Otorhinolaryngol 1994;251:6771

2RC Haggitt . Histopathology of reflux-induced esophageal and supraesophageal injuries. Am J Med 2000;108:109111S

3B Benjamin , J Roche . Vocal granuloma, including sclerosis of the arytenoid cartilage: radiographic findings. Ann Otol Rhinol Laryngol 1993;102:756–60

4TL Miko . Peptic (contact ulcer) granuloma of the larynx. J Clin Pathol 1989;42:800–4

5HT Hoffman , E Overholt , M Karnell , TM McCulloch . Vocal process granuloma. Head Neck 2001;23:1061–74

6JE Delahunty , J Cherry . Experimentally produced vocal cord granulomas. Laryngoscope 1968;78:1941–7

7RJ Feder , MJ Michell . Hyperfunctional, hyperacidic, and intubation granulomas. Arch Otolaryngol 1984;110:582–4

13JP Benaixa , F Esteban , JM Gonzalez-Perez , R Martinez-Garrido . Treatment of laryngeal granuloma with anti-extraesophageal reflux medication [in Spanish]. Acta Otorrinolaringol Esp 2003;54:501–5

14S Hirano , H Kojima , I Tateya , J Ito . Fiberoptic laryngeal surgery for vocal process granuloma. Ann Otol Rhinol Laryngol 2002;111:789–93

15SB Clyne , SL Halum , JA Koufman , GN Postma . Pulsed dye laser treatment of laryngeal granulomas. Ann Otol Rhinol Laryngol 2005;114:198201

17EM Lemos , LU Sennes , R Imamura , DH Tsuji . Vocal process granuloma: clinical characterization, treatment and evolution. Rev Bras Otorrinolaringol 2005;71:494–8. PMID: 16446966

19M Jaroma , L Pakarinen , J Nuutinen . Treatment of vocal cord granuloma. Acta Otolaryngol 1989;107:296–9

20CS Bloch , WJ Gould , M Hirano . Effect of voice therapy on contact granuloma of the vocal fold. Ann Otol Rhinol Laryngol 1982;90:4852

21C Jackson . Contact ulcer of the larynx. Ann Otol Rhinol Laryngol 1928;37:227–30

22PM Harari , SJ Blatchford , SW Coulthard , JR Cassady . Intubation granuloma of the larynx: successful eradication with low-dose radiotherapy. Head Neck 1991;13:230–3

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *