Nonarytenoid Laryngeal Granulomas

The most common presenting symptom is hoarseness, with sore throat, dyspnea on exertion, globus, stridor, and "cut-off voice" occurring less commonly.1 Contact granulomas result from trauma, often due to laryngopharyngeal reflux, chronic cough, and throat clearing, as well as vocal abuse. The senior author (R.T.S.) has described a case ofbilateral granuloma and varicosity in the midportion of the vocal folds, as well as a laryngeal granuloma of the false vocal fold.6,7 The natural course and treatment of contact versus postintubation granulomas differ, as contact granulomas have a high likelihood of recurrence (92%) when removed surgically.8 The mainstay of treatment of contact granulomas is conservative, consisting initially of anti-reflux medication and voice therapy. Surgical removal is reserved primarily for cases refractory to medical treatment or when the diagnosis is in doubt, and "bloodless" in-office techniques such as KTP laser treatment can offer increased accessibility, decreased morbidity, and lower recurrence rates than traditional cold steel microlaryngoscopy techniques, but at the expense of complete histologic evaluation.9,10 References 1.