Skip to main content Accessibility help

Assessing the utility of non-surgical treatments in the management of vocal process granulomas

  • J R Rudman (a1), C S McGee (a1), J Diaz (a1) and D E Rosow (a1)



To determine whether patients would have equivalent or improved outcomes when receiving non-surgical management versus surgical removal for vocal process granulomas.


A chart review was performed for 53 adults with vocal process granulomas. All patients received baseline anti-reflux treatment consisting of twice-daily proton pump inhibitors and vocal hygiene education. Further treatment approaches were divided into non-surgical (i.e. inhaled corticosteroids, voice therapy, botulinum toxin injections) and surgical groups. Subjective parameters (Voice Handicap Index 10 and Reflux Symptom Index) and outcomes were tabulated and statistically compared. Cause of granuloma was also analysed to determine if this influenced outcomes.


Of 53 patients, 47 (89 per cent) experienced reduction in granuloma size, while 37 (70 per cent) experienced complete resolution. The rate of complete granuloma resolution after initial treatment strategy alone was significantly higher in non-surgical compared to surgical patients (67 and 30 per cent, respectively; p = 0.039). No difference in outcome was seen between iatrogenic and idiopathic granulomas.


Non-surgical patients were more likely to experience initial treatment success than those who underwent surgical removal. Continued emphasis should be placed on conservative treatment options prior to surgery for patients with this condition.


Corresponding author

Author for correspondence: Dr David E Rosow, Department of Otolaryngology, University of Miami Miller School of Medicine, 5th floor, 1120 NW 14th Street, Miami, FL33136, USA E-mail: Fax: +1 305 243 2009


Hide All

Dr D E Rosow takes responsibility for the integrity of the content of the paper

Presented at the Fall Voice Conference, 12–14 October 2017, Pentagon City, Washington, DC, USA.



Hide All
1Jackson, C. Contact ulcer of the larynx. Ann Otol Rhinol Laryngol 1928;37:228–30
2Wang, CP, Ko, JY, Wang, YH, Hu, YL, Hsiao, TY. Vocal process granuloma - a result of long-term observation in 53 patients. Oral Oncol 2009;45:821–5
3Havas, TE, Priestley, J, Lowinger, DS. A management strategy for vocal process granulomas. Laryngoscope 1999;109:301–6
4Clausen, RL. Unusual sequelae of tracheal intubation. Proc R Soc Med 1932;25:1507
5Brodnitz, F. Contact ulcer of the larynx. Arch Otolaryngol Head Neck Surg 1961;74:7080
6Ylitalo, R, Hammarberg, B. Voice characteristics, effects of voice therapy, and long-term follow-up of contact granuloma patients. J Voice 2000;14:557–66
7Karkos, PD, George, M, Van Der Veen, J, Atkinson, H, Dwivedi, RC, Kim, D et al. Vocal process granulomas: a systematic review of treatment. Ann Otol Rhinol Laryngol 2014;123:314–20
8Hillel, AT, Lin, LM, Samlan, R, Starmer, H, Leahy, K, Flint, PW. Inhaled triamcinolone with proton pump inhibitor for treatment of vocal process granulomas: a series of 67 granulomas. Ann Otol Rhinol Laryngol 2010;119:325–30
9Wang, CT, Lai, MS, Hsiao, TY. Comprehensive outcome researches of intralesional steroid injection on benign vocal fold lesions. J Voice 2015;29:578–87
10Nasri, S, Sercarz, JA, McAlpin, T, Berke, GS. Treatment of vocal fold granuloma using botulinum toxin type A. Laryngoscope 1995;105:585–8
11Yilmaz, T, Kayahan, B, Gunaydin, RO, Kuscu, O, Sozen, T. Botulinum toxin A for treatment of contact granuloma. J Voice 2016;30:741–3
12Fink, DS, Achkar, J, Franco, RA, Song, PC. Interarytenoid botulinum toxin injection for recalcitrant vocal process granuloma. Laryngoscope 2013;123:3084–7
13Song, Y, Shi, L, Zhao, Y, Zhao, D, Shi, M, Deng, Z. Surgical removal followed by radiotherapy for refractory vocal process granuloma. J Voice 2012;26:666.e1–5
14Rosen, CA, Lee, AS, Osborne, J, Zullo, T, Murry, T. Development and validation of the voice handicap index-10. Laryngoscope 2004;114:1549–56
15Belafsky, PC, Postma, GN, Koufman, JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002;16:274–7
16Lei, L, Yang, H, Zhang, X, Ren, J. Comparison of the effects of esomeprazole plus mosapride citrate and botulinum toxin A on vocal process granuloma. Am J Otolaryngol 2017;38:593–7
17Pham, J, Yin, S, Morgan, M, Stucker, F, Nathan, CO. Botulinum toxin: helpful adjunct to early resolution of laryngeal granulomas. J Laryngol Otol 2004;118:781–5
18Mascarella, MA, Young, J. In-office excision en masse of a vocal process granuloma using the potassium-titanyl-phosphate laser. J Voice 2016;30:93–5
19Ma, L, Xiao, Y, Ye, J, Yang, Q, Wang, J. Surgical excision and botulinum toxin A injection for vocal process granuloma [in Chinese]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015;29:140–3
20Hong-Gang, D, He-Juan, J, Chun-Quan, Z, Guo-Kang, F. Surgery and proton pump inhibitors for treatment of vocal process granulomas. Eur Arch Otorhinolaryngol 2013;270:2921–6
21Ylitalo, R, Lindestad, PA. A retrospective study of contact granuloma. Laryngoscope 1999;109:433–6


Assessing the utility of non-surgical treatments in the management of vocal process granulomas

  • J R Rudman (a1), C S McGee (a1), J Diaz (a1) and D E Rosow (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed