Summary about Disease
Vocal cord granulomas are benign (non-cancerous) growths that typically develop on the vocal cords, most commonly at the back (posterior larynx) of the vocal folds. They are characterized by inflamed tissue and are often a reaction to local irritation or injury. While not life-threatening, they can significantly impact voice quality and cause discomfort.
Symptoms
Common symptoms of vocal cord granulomas include:
Hoarseness
A "lump in the throat" sensation
Chronic cough
Throat clearing
Pain in the throat, especially with speaking
Vocal fatigue
Globus sensation (feeling of something stuck in the throat)
Voice changes (roughness, breathiness, reduced pitch range)
Causes
The most frequent causes are:
Laryngopharyngeal Reflux (LPR): Stomach acid flowing back up into the larynx (voice box) irritates the vocal cords.
Intubation Trauma: Injury to the vocal cords during surgery or medical procedures requiring intubation (breathing tube).
Vocal Abuse/Misuse: Excessive or improper use of the voice, such as yelling, singing incorrectly, or chronic coughing. Less Common Causes:
Chronic irritation or inflammation
Persistent cough
Trauma to the larynx
Medicine Used
Medications used to treat vocal cord granulomas often target the underlying cause and reduce inflammation:
Proton Pump Inhibitors (PPIs): Reduce stomach acid production to treat LPR (e.g., omeprazole, lansoprazole).
H2 Receptor Antagonists: Another class of acid-reducing medications (e.g., ranitidine, famotidine).
Corticosteroids: To reduce inflammation (may be inhaled, oral, or injected).
Antibiotics: If secondary bacterial infection is suspected.
Pain Relievers: To manage discomfort.
Is Communicable
No, vocal cord granulomas are not communicable. They are not caused by an infectious agent and cannot be spread from person to person.
Precautions
Precautions to help prevent vocal cord granulomas and manage symptoms include:
Voice Rest: Avoiding excessive talking, yelling, or singing.
Vocal Hygiene: Drinking plenty of water, avoiding irritants like smoke and alcohol, and using proper vocal techniques.
Reflux Management: Following dietary and lifestyle recommendations to minimize acid reflux (avoiding late-night meals, elevating the head of the bed).
Proper Cough Technique: Addressing any persistent cough with medical attention and using a gentle cough technique when necessary.
Avoid Throat Clearing: Excessive throat clearing can irritate the vocal cords.
How long does an outbreak last?
The duration of a vocal cord granuloma outbreak varies greatly depending on the underlying cause, the severity of the granuloma, and how well the individual responds to treatment. With appropriate management, symptoms may improve within weeks to months. However, recurrence is possible if the underlying cause is not adequately addressed. Some granulomas may persist for longer periods and require more aggressive intervention.
How is it diagnosed?
Diagnosis typically involves:
Medical History: Review of symptoms, medical conditions (especially reflux), and vocal habits.
Physical Examination: Examination of the head and neck.
Laryngoscopy: Visualization of the vocal cords using a flexible or rigid laryngoscope (a thin, lighted tube inserted through the nose or mouth). This allows the doctor to directly view the vocal cords and identify any abnormalities.
Voice Evaluation: Assessment of voice quality, pitch, loudness, and other vocal parameters by a speech-language pathologist.
Biopsy (Rare): In some cases, a biopsy may be performed to rule out other conditions, but is not typically necessary for diagnosing granulomas.
Timeline of Symptoms
The timeline of symptom development can vary.
Gradual Onset: Most commonly, symptoms develop gradually over weeks or months.
Initial Irritation: A sensation of irritation or discomfort in the throat.
Voice Changes: Hoarseness or other voice changes become noticeable.
Increased Discomfort: As the granuloma grows, the sensation of a lump in the throat or pain may increase.
Fluctuating Symptoms: Symptoms may fluctuate, worsening with voice use or reflux episodes.
Important Considerations
Differential Diagnosis: It's important to rule out other conditions that can cause similar symptoms, such as vocal cord nodules, polyps, cysts, or laryngeal cancer.
Multidisciplinary Approach: Management often involves a team of specialists, including an otolaryngologist (ENT doctor), a gastroenterologist (if reflux is suspected), and a speech-language pathologist.
Compliance with Treatment: Adherence to medication regimens and voice therapy recommendations is crucial for successful treatment.
Recurrence: Granulomas can recur, especially if the underlying cause (e.g., reflux or vocal abuse) is not adequately managed.
Surgery: Surgical removal of the granuloma may be considered if conservative treatments are unsuccessful, but is usually reserved for cases that don't respond to other therapies.