Effect of voice therapy on contact granuloma of the vocal fold.

Contact granuloma of the vocal folds caused by physical trauma secondary to voice abuse has traditionally been treated by surgical removal. This mode of handling can be frequently disappointing since these lesions have a strong tendency to recur and may require additional operative procedures. This paper describes 17 patients in whom treatment of the primary problem was approached through voice therapy. Treatment consisted of a comprehensive history and voice evaluation, stress reduction, relaxation methods, auditory and kinesthetic feedback, pitch change and elimination of voice abuse. Patients were closely followed by the speech pathologist and laryngologist who worked together as a team. The results of voice therapy were evaluated by the laryngologist, the speech pathologist and the patient himself. As a result of voice therapy, the granuloma disappeared in 9 patients, was reduced in size in 4 and remained unchanged in 1. For the remaining three patients, posttherapeutic laryngoscopic findings were not available. The speech pathologist found voice and manner of phonation returned to normal in 4 patients, improved in 7 and remained unchanged in 6. Four patients felt that complete recovery had taken place, 10 felt that some improvement was noted, and 3 felt no change had taken place. Based on the assessments of all three evaluators, the success rate of treatment with voice therapy can be stated as 71% (12 of 17 cases) or 100% (eliminating 5 of 17 cases who terminated treatment very early).