Laryngeal granuloma is a benign mass of granulation tissue that develops on or adjacent to the vocal process (vocal projection of the arytenoid cartilage). It has two main subtypes: (1) Intubation granuloma — results from pressure trauma of the endotracheal tube on the vocal process, developing 2-12 weeks post-surgery. (2) Contact granuloma (reflux granuloma) — results from gastroesophageal reflux irritating the vocal process mucosa or vocal processes striking each other during phonation. On imaging, it appears as a small, well-defined, homogeneously enhancing nodular lesion on the vocal process. Distinction from SCC is critical.
Age Range
20-70
Peak Age
45
Gender
Male predominant
Prevalence
Common
In intubation granuloma, pressure from the endotracheal tube on the vocal process mucosa in the posterior glottis causes ischemic necrosis and ulceration. During healing, excessive granulation tissue (fibroblasts, neovascularization, inflammatory cells) is produced, forming a polypoid mass. In contact granuloma, two mechanisms are involved: (1) GERD-related acid reflux irritates the laryngeal mucosa — chronic chemical irritation triggers granulation tissue formation. (2) Aggressive or improper phonation technique causes the vocal processes to strike each other forcefully — repeated mechanical trauma leads to ulceration and granuloma formation. On imaging: granulation tissue enhances because it is vascularized; small size and smooth margins reflect benign nature; mild hyperintensity on T2 reflects water content of edema and granulation tissue. Posterior glottis localization is characteristic — lesions at anterior or mid-cord location should prompt consideration of other diagnoses.
Small, well-defined, homogeneously enhancing nodule on the vocal process (arytenoid) — posterior glottis localization is characteristic for intubation or GERD granuloma.
On contrast-enhanced CT, a small (usually 5-10mm), well-defined, homogeneously enhancing nodular lesion on or adjacent to the vocal process. Unilateral location in the posterior glottis is typical. Lesion density is similar to soft tissue or slightly hypodense. Enhancement is homogeneous and moderate — reflecting vascularity of granulation tissue. Thyroid cartilage, cricoid cartilage intact, no erosion.
Report Sentence
A __ x __ mm well-defined, homogeneously enhancing nodular lesion is seen on the [right/left] vocal process. No cartilage erosion or invasion is present. In conjunction with clinical information, laryngeal granuloma is primarily considered.
On MRI T2-weighted sequences, a mildly to moderately hyperintense, well-defined small nodule on the vocal process. Isointense on T1. Homogeneous enhancement on post-contrast sequences. Edema component is highlighted on STIR. Diffusion restriction is usually absent (low cellularity).
Report Sentence
On MRI, a small nodular lesion on the [right/left] vocal process showing mild hyperintensity on T2, isointensity on T1, and homogeneous enhancement on post-contrast sequences. No diffusion restriction is seen.
On non-contrast CT, a small soft tissue density nodule adjacent to the vocal process in the posterior glottis. Critical negative findings: arytenoid cartilage in normal shape and position, no erosion in thyroid and cricoid cartilage, paraglottic fat planes preserved. If similar lesion is present on the contralateral vocal process, bilateral contact granuloma is considered.
Report Sentence
A small soft tissue density nodular lesion is seen adjacent to the [right/left] vocal process in the posterior glottis. Arytenoid, thyroid, and cricoid cartilages are normal. Laryngeal granuloma is considered in the differential given the clinical history.
On transcervical ultrasonography, a small hypoechoic or isoechoic nodular lesion in the posterior glottis. Smooth borders. Minimal vascularity may be seen on Doppler. US is helpful in dynamically assessing vocal cord mobility — whether the granuloma restricts cord movement can be observed.
Report Sentence
A small hypoechoic nodular lesion is seen in the posterior glottis on transcervical US. Vocal cord mobility is [preserved/restricted]. Further evaluation with CT or MRI is recommended.
Laryngeal granuloma does not show significant diffusion restriction on DWI. ADC values are normal or mildly elevated. This is an additional helpful finding for distinction from SCC — significant diffusion restriction is expected in SCC due to high cellularity.
Report Sentence
No significant diffusion restriction is seen in the vocal process lesion on DWI. ADC values are normal. This finding argues against malignancy.
Criteria
History of endotracheal intubation, development 2-12 weeks after
Distinct Features
Usually regresses spontaneously. Prolonged intubation, female sex, and use of large tube are risk factors. May be bilateral.
Criteria
GERD history, vocal abuse, no intubation history
Distinct Features
May regress with PPI therapy and voice therapy. Recurrence is common. Contact ulcer on contralateral side may accompany ('ulcer-granuloma complex').
Criteria
History of Teflon injection for vocal cord medialization
Distinct Features
Granuloma from foreign body reaction. High-density Teflon deposit with surrounding granulation tissue on CT. Teflon is no longer used; seen in historical cases.
Distinguishing Feature
Reinke edema is bilateral diffuse cord involvement; granuloma is focal, localized on the vocal process.
Distinguishing Feature
Subglottic stenosis is concentric, at cricoid level; granuloma is focal, at glottic level.
Distinguishing Feature
Epiglottitis involves supraglottic structures; granuloma is at glottic level on vocal process. Epiglottitis has acute fever and infection.
Urgency
routineManagement
conservativeBiopsy
Not NeededFollow-up
3-monthPrimary treatment is conservative: PPI (if GERD present), voice therapy, voice rest. Intubation granulomas usually regress spontaneously in 6-12 months. Laryngoscopic biopsy + excision is performed in refractory cases or when SCC exclusion is needed. Post-surgical recurrence rate is high (30-50%), so the underlying cause (GERD, vocal abuse) must be treated.
Treatment includes proton pump inhibitor (PPI) and voice therapy. Intubation granuloma usually regresses spontaneously. Surgical excision can be performed in refractory cases but recurrence risk is high. Biopsy may be needed to exclude SCC.