Related Experiment Video
Updated: Jun 19, 2026

Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing
Published on: December 1, 2023
Vocal process granuloma and glottal insufficiency: an overlooked etiology?
Thomas L Carroll1, Jackie Gartner-Schmidt, Melissa M Statham
1Tufts Medical Center, The Center for Voice and Swallowing, Boston, Massachusetts, USA.
Objectives/Hypothesis:
Vocal process granuloma has been attributed to intubation, laryngopharyngeal reflux, and phonotraumatic/hyperfunctional vocal behaviors. Vocal process granuloma has recurrence rates following surgical excision approaching 92%. We hypothesize that a portion of persistent or idiopathic cases of vocal process granuloma result from underlying glottal insufficiency (GI) caused by paresis, scar, or atrophy. Our goal was to examine our vocal process granuloma population and determine the incidence of GI, treatment interventions, and outcomes.
Study Design:
Retrospective chart review.
Methods:
Thirty-four patients with vocal process granuloma were divided into surgically or conservatively managed groups. Patients were identified if they carried a diagnosis of GI. The time to resolution and number of recurrences within the overall treatment period was recorded and compared between subgroups. Pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Reflux Symptom Index (RSI) scores were compared.
Results:
Eighteen of 34 patients (53%) carried an underlying diagnosis of GI, 13/34 (38%) were treated surgically, and 8/13 (62%) surgical patients had underlying GI. VHI-10 and RSI scores significantly improved after disease resolution (P < .05).
Conclusions:
The incidence of GI among patients with vocal process granuloma was 53%. Conservative therapies including treatment of laryngopharyngeal reflux and voice therapy may lead to resolution despite underlying glottal incompetence. If conservative measures fail, recognizing and treating glottal incompetence with true vocal fold augmentation may lead to a shorter surgical treatment course.
Related Concept Videos
Larynx
Anatomy of the Larynx
The larynx consists of various components, including cartilage, muscles, and vocal cords. Its structure includes three large unpaired cartilages—the thyroid, cricoid, and epiglottis—and three smaller paired cartilages—the arytenoids, corniculates, and...
Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:
Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
Physical Assessment of the Respiratory Tract IV: Auscultation
Breath Sounds
Breath sounds are categorized into vesicular, bronchovesicular, and bronchial.
Atelectasis II: Pathophysiology
Respiratory System Abnormal Finding I: Inspection and Percussion
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...