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Hemorrhagic Vocal Process Granuloma

A 52-year-old man with intermittent hoarseness was found to have a large left vocal process granuloma (figure 1). A surgical resection was performed, and the patient's symptoms began resolving. Within 10 months of the procedure, however, a small granuloma had recurred; the lesion was associated with a prominent feeding vessel (figure 2). Because the patient's voice had been continuing to improve, the decision was made not to vaporize the vessel. However, over the succeeding few weeks, the patient's voice worsened. The deterioration was characterized by raspiness and fatigue. It was not associated with any phonotrauma. Strobovideolaryngoscopy detected a hemorrhage into the vocal process granuloma (figure 3). Spontaneous resolution was in progress 2 weeks later (figure 4). Vocal process granuloma, also known as contact granuloma! or intubation granuloma, is a benign chronic inflammatory lesion that commonly arises from the mucosa overlying the arytenoid cartilage and extending to the posterior one-third of the vocal fold.' These lesions form in response to irritation or inflammatory insults to the vocal process. In addition, damage and Figure 2. Image shows the recurrent granuloma and associated feedingvessel.