#6 Granuloma and Granulation: Same or Different?

SASS Clinical Note #6

Granuloma and Granulation: Same or Different?

SLPs using endoscopy, either flexible or rigid, to view the larynx and pharynx frequently encounter lesions or masses. While not officially making a medical diagnosis, many of these lesions have specific visual characteristics and locations that help to define them and raise suspicions. Two such lesions are granulomas and granulation tissue; are they the same or different? Because the terminology appears very similar, they may be erroneously used interchangeably.


• are usually rounded, reddish, or pale benign lesions found on the medial surface of the vocal process of the arytenoid in the posterior glottis.

• may also appear as a smooth spherical mass concave, or ulcerated, either with a broad base or narrow-necked.

• are inflammatory reactions to epithelium injury.

• some are idiopathic, but most are attributed to reflux, vocal abuse, and intubation.

• may be asymptomatic or present with dysphonia of varying degrees, throat discomfort, and dyspnea with larger, more bulky lesions.

• are also called “contact ulcers”, “vocal process granuloma” (Hoffman, Overholt, Karnell, & McCulloch, 2001), “inflammatory granulation tissue” (Shoffel-Havakuk et al., 2014), or “laryngeal arytenoid granuloma” (Carroll et al., 2010).(https://voice.weill.cornell.edu/voice-disorders/granuloma).

• tend to occur with “long term” intubation (M = 7.3 days) and may be exacerbated by reflux. Weill Cornell Medicine, Sean Parker Institute for the Voice. Granuloma.https://voice.weill.cornell.edu/voice-disorders/granuloma. Taken January 26, 2022.

Granulation Tissue

• a component of the wound healing process

• forms when the wound edges do not approximate to heal and fill the wound

• provides a new connective tissue and microscopic blood vessels in the wound

• protects the wound surface from microbial invasion and further injury

• fills in the wound base

• replaces necrotic tissue until scar tissue can develop

• Excess granulation tissue forms from

o Wound infection

o Excess inflammation

o Foreign body/material

o Physical irritation/friction, i.e. trach tubes, voice prostheses

Alhajj M, Goyal A. Physiology, Granulation Tissue. [Updated 2021 Oct 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK554402/

September 2022