A 55-year-old man with right-sided throat pain and chronic dysphonia is suspected to have which condition?

• A. Vocal fold sulcus
• B. Vocal fold granuloma
• C. Vocal fold polyp
• D. Vocal fold nodules

Answer: (B)

Vocal fold granuloma forms as inflammatory granulation tissue at the posterior part of the glottis, usually where the arytenoids meet the vocal folds. This location makes it a common source of throat pain and chronic dysphonia, since irritation and inflammation in the posterior larynx directly affect voice production and can cause a sore, persistent throat sensation. It often arises from irritation or trauma—such as reflux, coughing, or post-intubation events—that stimulate a granulomatous response, and it can be unilateral, aligning with the patient’s right-sided symptoms.

In contrast, nodules and polyps typically affect the mid-mportion of the vocal folds and present mainly with voice changes like hoarseness or breathiness, often without significant throat pain. Sulcus is a groove along the vocal fold that changes voice quality rather than producing focal throat pain. Therefore, the combination of throat pain with chronic dysphonia points most to a posterior vocal fold granuloma, especially when irritation or reflux is a plausible contributing factor. Management centers on treating the underlying cause, alongside voice therapy; surgery is considered if the lesion persists.