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Do I need surgery to treat a vocal granuloma?
Question: I recently went to an ENT because I was hoarse. I was diagnosed with a granuloma in my throat. The doctor recommended medication and also surgery and a Botox injection. She told me the Botox would give me a soft voice for several months after the procedure. I am a professional director and I need to use my voice. Are there any alternatives to surgery and Botox for a vocal granuloma?
- The left image is a granuloma at the time of diagnosis. The image at right is after three months of appropriate treatment, without surgery.
Answer: There are definitely alternatives to surgery for vocal granuloma. As a matter of fact, surgery should very rarely be used to treat a granuloma.
Granulomas occur because of an injury to the back of the larynx (voice box). This injury may be due to voice overuse, voice misuse, intubation for surgery (general anesthesia) or other similar reasons. When an injury occurs in the back of the larynx, it exposes an area of vocal cartilage, called the arytenoid cartilage. This exposed cartilage becomes inflamed and forms a granuloma.
Once a granuloma has formed, it takes significant time and care for it to heal. Continued voice misuse and overuse delays the healing process. Most patients who have granulomas also suffer from a degree of acid reflux. This will also prevent the granuloma from healing.
Appropriate treatment, therefore, includes voice therapy and medications for acid reflux. It is important to realize that while it seems simple, this treatment is not that easy to get. Doctors often do not understand the correct treatment of acid reflux and treat it incorrectly. Lifestyle modifications and medications are critical to effective treatment. Additionally, all voice therapy is not created equal. You must have the best of both of these to have any hope of a non-surgical cure.
With appropriate treatment your vocal granuloma can resolve within a few months.
Key Points
- Vocal granuloma does not require surgery for effective treatment.
- This treatment includes voice therapy by a skilled therapist and maximum reflux management.
Video:
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