Vocal process granuloma of the larynx-recognition, differential diagnosis and treatment

The vocal process granuloma is a nonneoplastic lesion that most often develops in the vicinity of the posterior vocal cords, adjacent to the vocal process. It may be an ulcerated region of the cord, or it may manifest as a nodular polypoid lesion. Causative factors include gastroesophageal reflux, intubation trauma, and vocal abuse. This lesion may be mistaken on clinical or pathologic grounds for carcinoma, although thorough microscopic examination usually permits a correct diagnosis. Despite its name, vocal process granuloma is not a true granulomatous process in a pathologic sense (inasmuch as it lacks aggregates of mononuclear and multinucleated histiocytes)-rather, it is a reactive/reparative process, in which an intact or ulcerated squamous epithelium is underlaid by granulation tissue or fibrosis. Treatment of vocal process granuloma centers around conservative voice therapy, coupled with treatment of any underlying inciting cause (such as gastroesophageal reflux). While it may recur locally (particularly if the original inciting cause persists), vocal process granuloma has no premalignant potential.