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.
Granulomas
• 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