Vocal Process Granulation Tissue vs. Vocal Process Granuloma
These terms are used interchangeably in clinical practice to describe the same pathologic entity—they both refer to a reactive/reparative lesion at the vocal process characterized by granulation tissue formation, not a true granulomatous process. 1
Pathologic Identity
The distinction you're asking about is largely semantic rather than clinically meaningful:
- "Vocal process granuloma" is the traditional clinical term used to describe these lesions, though it's a misnomer from a pathologic standpoint 1
- "Granulation tissue" more accurately describes the histopathologic composition of these lesions 1
- Both terms refer to the same reactive process: an intact or ulcerated squamous epithelium underlaid by granulation tissue or fibrosis, without the aggregates of mononuclear and multinucleated histiocytes that define true granulomatous inflammation 1
Key Pathologic Features
The lesion consists of:
- Excessive proliferation of granulation tissue at the vocal process 2, 1
- May present as an ulcerated region or nodular polypoid lesion 1
- Located most often in the vicinity of the posterior vocal cords, adjacent to the vocal process 1
- Histologically shows fibroblasts, myofibroblasts, and loose collagen—not true granulomas 1
Clinical Implications of the Terminology
The name "granuloma" persists in clinical usage despite being pathologically inaccurate, but this doesn't change diagnosis or management. 1 What matters clinically:
- Etiology: Most commonly associated with laryngopharyngeal reflux, followed by intubation trauma and vocal abuse 2, 1
- Treatment approach: Conservative management with proton pump inhibitors, voice therapy, and addressing underlying causes is first-line, regardless of what you call it 3, 4
- Prognosis: High spontaneous remission rates (81%) with observation alone, typically within 30.6 weeks 5
- No malignant potential: This is a benign reactive process with no premalignant potential 1
Important Clinical Caveat
Do not confuse vocal process granuloma with membranous vocal fold granuloma—the latter is a distinct entity that develops on the membranous vocal fold (not the vocal process) as a complication of microlaryngoscopic surgery, typically appearing within 8 weeks postoperatively. 6 This is a different clinical scenario with different implications.