community for people with voice problems started by The Lary Project

Contact Granuloma

I thought it was about time I got around to telling my story - partly to see who else out there has had similar experiences and also to provide a positive message to others. It's almost a year to the day that I was diagnosed with a contact granuloma, my voice had got progressively worse over about 6 weeks, to the point where I couldn't really talk at all. Several trips to the GP were getting me nowhere and I was lucky enough to have private medical insurance so I saw my local ENT specialist and had my first operation just before Christmas 2010 to remove the granuloma. I started seeing an excellent voice therapist and my voice started to improve, although working at the same time was tough, especially in a demanding job where I rely on my voice. By late February it was rapidly declining and I soon learned that I needed a second operation in early April with the same surgeon (this time using a laser rather than cold steel). So I was back to square one. This time I decided to take 10 weeks off work so I could recover without the stress of working. Then came the devastating news in May that it was back again. The voice therapy masked some of the problems, as my voice wasn't as bad as it could have been but I needed a miracle, I wasn't prepared to be operated on again without something changing. So I went to see the highly respected John Rubin, who then operated on me in July, this time using Botox to soften the aggressive nature of my larynx and allow the granuloma to heal. He did an excellent job and 6 months on, the granuloma has not returned.

I wish that I was completely normally again, but my left vocal fold is still weak, and doesn't work that well but it has improved slowly bit by bit. By the end of the day my voice gets very tired and I really can't cope with noisy places - this problem has really affected by social life. Yet despite the daily challenges, I now have my career back (my employer has been very supportive) and it's great to put the granuloma behind me. Maybe I will never be normal, but I'm grateful for what I have got! Happy Christmas fellow voice suffers - would love to hear from other granuloma sufferers.

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Comment by Janet Taplin on December 16, 2011 at 8:44am: Hello Thomas, you do seem to have had a traumatic year vocally! I'm pleased to hear that John Ruben was able to restore your voice and let the granuloma heal. Will you have to have repeats of the Botox?

I also have a weak left vocal fold (caused by nerve damage) and like you although my voice is pretty good until I try to cope with noisy situations and once pushed my voice falls off a cliff and I am left squeaking!

I think that a voice problem is certainly character forming, and I know I will never be an opera singer (Probably for the best, as I'm tone deaf!) but being a cup half full person I look to the positives of my condition, it has shown me the more caring side of many people including my work collegues, who without asking have attended meetings with me to do the donkey share of the talking for me if I have sounded croaky...

who wants to be normal anyway, different is interesting

Comment by Terence McDermott on December 17, 2011 at 11:31pm: Hi Thomas. I have a history of contact granuloma. You can't see it in the attached image but you can see that my larynx puts too much pressure in the upper part causing the granuloma to form on the right fold edge. A number of things seem important in controlling granuloma formation:

1. speaking without unnecessary force (eg. by over articulation to reduce strain on the larynx, not speaking louder than you need to, good breath support)

2. controlling reflux (Gaviscon advance and PPIs can be useful here)

3. avoid throat clearing

4. Exercises that encourage the lower (anterior I think they call it) part of the folds to come together so you are not overpressing in the superior area.

5. Watching voice use when one has an upper respiratory tract infection (eg. cold)

I had a granuloma removed in Feb 2008 and it did not reform again until end 2010/beginning 2011. I had it removed in July by laser and hoping that it won't return if I follow the above tips. What advice do you follow?

Best, Terry

Comment by Thomas Fuller on December 20, 2011 at 6:00pm: @Janet - Thanks Janet, it was really good to hear about your experiences - you're quite right though people are very kind and understanding once they know about your problem. I don't think I will be having repeats of the Botox, it was only meant to be a one off in my situation - I'll never forget the lady in Morrisons who thought I was deaf (I did sound awful)!

@Terry, thanks for the message - you're the first person I've ever heard from who has a similar condition. I did a lot of research into the condition and it's relatively unusual nature makes it hard to really get good evidence of what works and what doesn't.

So I follow a similar routine to you....

1. Voice therapy - which has taught me to avoid the 'glottal attacks', and the breath support really helps

2. Controlling reflux - I take 2x20mg of Nexium, 300mg of Ranitidine and Gaviscon Advance after after meal - I think I should have share in Reckitt Benckiser, it's expensive stuff! I have never really had a reflux problem, so I'm a bit nervous about how long I stay on these drugs.

3. Avoiding throat clearing - definitely, I did that alot before I got the granuloma

4. I can only survive with exercises which reduce the constriction in my throat - secret smiling, silent giggles, etc all really help my voice sound better

5. Yes, I go very quiet when I have a cold, definitely time to hibernate.

6. No caffeine, very very little alcohol and a low acid diet (no carbonated drinks, tomatoes, chocolate, onions)

I do think that the Botox was the key factor which helped my granuloma to go away, I'm pretty positive that with this regime it will not come back.

In terms of root causes, some research has linked granulomas to certain professions (such as business executives and lawyers), certain personality types (perfectionists in particular), and also the businessman's diet of late nights, eating late etc. I also did like my spicy food, which is known to damage the mucosa. Some research has suggested that an episode of stress can cause granulomas. I pretty much ticked all of these boxes, so I am not surprised I got ill.

So I've changed my lifestyle radically, and I'm hoping that will keep me granuloma free....

Tom

Comment by Terence McDermott on December 20, 2011 at 11:53pm: Hi Tom.... Tell us more about secret smiling and silent giggles!!! I haven't heard of those.... I do other things to reduce laryngeal tension such as accent method (zzz, prrrrrrr, sssss), yawning, jaw waggling, trilling and also laryngeal massage).

I trust you are getting nexium and Gaviscon advance on prescription otherwise it would bankrupt you! You can buy a prepayment prescription for the year at about £100 odd to cover costs for the year. Presume you know this but worth saying just in case!

Terry

Comment by Thomas Fuller on December 21, 2011 at 2:42pm: Thanks Terry, I have a prescription for the PPIs but not the Gaviscon, so I will get that sorted in the new year.

The silent giggles and secret smiles are similar to the yawning - the silent giggles are pretty much what they sound like, just try and giggle as if you were really laughing but dont make a sound. You should feel your throat stretching and relaxing. The smiles are not as effective, just try and smile without actually looking like you are. Although it's taken me months to master them, and still some way to go yet....

Tom

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