title: Vocal process granuloma and glottal insufficiency: an overlooked etiology?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Tufts Medical Center, The Center for Voice and Swallowing, Boston, Massachusetts, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Carroll
authors.forename: Jackie
authors.initials: J
authors.lastname: Gartner-Schmidt
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Statham
authors.forename: Clark A
authors.initials: CA
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005931:Glottis / Q000503:physiopathology*; D006102:Granuloma, Laryngeal / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D006801:Humans; D007223:Infant; D007818:Laryngeal Diseases / Q000150:complications / Q000503:physiopathology; D008297:Male; D012189:Retrospective Studies; D049489:Stroboscopy; D014741:Video Recording