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Granulomas are caused by a trauma of some type. A granuloma is an inflammatory reaction and the lump is filled with capillaries that can bleed. At the back of the vocal cord, the skin is very thin over the vocal process and is prone to injury from speaking at too low a pitch. This is most common in male executives, but occurs in women who try to speak low and with authority, rather than their comfortable speaking pitch. Granulomas can also be caused from an endotracheal tube that bruises the voice box. Again the most common location is the vocal process, but these may occur anywhere there is an injury.
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Immature granuloma |
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In this young female singer, she was leaking a lot of air. She was trying to speak with a very deep voice at work to promote her authority.
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In this young female singer, with the vocal cords open, one can see that the granuloma is immature, soft and has a broad base. It is located on the vocal process and likely caused by the trauma of the vocal processes striking one another. Now it is easy to see that it is on the right vocal process.
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Mature granuloma |
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With time a granuloma matures and becomes harder, whiter and develops a stalk. This one is on the left vocal process. It is also bilobed with another lobe below the left vocal process.
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Small bifed granuloma |
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This granuloma may have already fallen off.
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Flexible scope - extreme close up reveals the central ulceration on the right vocal process and the bifed nature of the granulomatous tissue because the opposite vocal process seats itself over the ulcer.
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Post intubation anterior commisure granuloma |
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Rigid endoscope: After an intubation the patient developed trouble with her voice. The anterior commmisure granuloma prevented the vocal cords from closing all the way.
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Flexible endoscope: the mass is in the midline. She coughed this out a few weeks later and needed no further treatment.
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Post intubation subglottic granuloma |
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After an intubation the patient developed difficulty breathing. The vocal cords could not open.
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And if one passes between the vocal cords, in the immediate subglottic area is a large granuloma.
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