The larynx, often called the voice box, is a complex structure of cartilage, muscle, and mucosa located in the neck. It serves as the gateway to the windpipe and is fundamental for breathing, swallowing, and voice production. A laryngeal granuloma is a non-cancerous, inflammatory mass that forms within the larynx, typically in response to chronic irritation or acute trauma. Understanding the nature of this benign growth, including its common triggers and management strategies, provides clarity on this specific laryngeal condition.
Defining Laryngeal Granuloma
A laryngeal granuloma is a benign, inflammatory growth of granulation tissue that develops within the voice box. This lesion forms specifically in the posterior glottis, where the vocal folds attach to the back of the larynx. The most common location is over the vocal process of the arytenoid cartilages, small structures that help open and close the vocal folds. This area has minimal soft tissue cushioning, making it susceptible to damage from impact and irritation.
The formation of a granuloma is the body’s protective mechanism, an overgrowth of tissue attempting to repair an injured mucosal lining. Unlike nodules or polyps, which form on the vibrating edge of the vocal folds, granulomas are distinct due to their specific posterior location. Granulomas can appear as reddish or pale mounds of tissue, sometimes growing large enough to obstruct the airway or interfere with normal vocal fold function.
Primary Causes and Risk Factors
Laryngeal granulomas are often multi-factorial, arising from a combination of different irritants and traumatic events. The three primary causes are trauma from intubation, chronic irritation from acid reflux, and excessive vocal effort.
A specific type, known as a post-intubation granuloma, occurs following general anesthesia that required a breathing tube. The insertion or movement of the endotracheal tube can cause mechanical trauma to the delicate lining over the arytenoid cartilage. This injury leads to the formation of granulation tissue as the area heals.
Laryngopharyngeal Reflux (LPR) is a widespread factor, involving the backflow of stomach acid and enzymes into the throat and voice box. The laryngeal mucosa is highly sensitive to this acidic exposure, causing irritation and inflammation. This chronic chemical burn significantly increases the likelihood of a granuloma developing, often in combination with other traumatic factors.
Phonotrauma, or the excessive and forceful use of the voice, is the third major cause, often called a contact granuloma. Activities like yelling or aggressive throat clearing cause the vocal processes of the arytenoid cartilages to slam together with excessive force. This repeated impact leads to ulceration and subsequent inflammatory tissue growth at the site of contact.
Recognizing the Symptoms
The symptoms of a laryngeal granuloma are primarily related to the lesion’s mass and location. Patients commonly experience dysphonia, or persistent hoarseness, which may be breathy because the mass prevents the complete closure of the vocal folds. This hoarseness may also be accompanied by intermittent voice breaks, especially if the granuloma is attached by a narrow stalk.
A distinguishing symptom is the perception of a foreign body in the throat, known as a globus sensation. Patients often report a persistent need to clear their throat due to this feeling, which only increases trauma to the granuloma. Laryngeal pain is frequently reported, which is unusual for most benign vocal lesions; this discomfort can sometimes radiate up to the ear. The constant irritation and vocal effort may also lead to vocal fatigue, causing the voice to tire quickly during speech.
Comprehensive Treatment Approaches
The management of a laryngeal granuloma focuses on eliminating the underlying cause of the irritation or trauma, often requiring a multi-faceted approach.
The initial and most effective strategy is medical management directed at neutralizing reflux, especially when LPR is a contributing factor. This typically involves aggressive anti-reflux medication, such as proton pump inhibitors (PPIs) or H2 blockers, to reduce the amount of acid reaching the larynx. Treating the chemical irritation allows the inflamed tissue time to heal and regress naturally.
Behavioral management is simultaneously initiated and is a cornerstone of non-surgical treatment. This involves working with a speech-language pathologist for voice therapy to modify vocal habits and reduce forceful impact on the vocal processes. Techniques are taught to minimize throat clearing and coughing and to use a less strenuous voice quality. Complete voice rest may also be recommended for short periods to allow acute irritation to subside.
Surgical intervention is typically reserved for cases where conservative treatments have failed, or if the granuloma is large enough to cause breathing difficulties. The procedure, often performed using microlaryngoscopy, involves carefully removing the granuloma. Surgery is approached cautiously because contact granulomas have a significant tendency to recur, sometimes becoming larger than the original lesion. Recurrence is particularly likely if the primary cause, such as aggressive reflux or vocal abuse, is not completely controlled.