SASS Clinical Note #6: Granuloma and Granulation Tissue: 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.  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 fills 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 protheses

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/

April 2025