Surgery and Recurrent Granulomas: Lessons From John Mayer

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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John Mayer released a statement today that states his vocal granuloma has regrown, and that his tour has to be cancelled because of this regrowth.  Mayer has been known to be struggling with a granuloma for some time, with a long hiatus and surgery as part of his treatment.

From his website:

“I went in for a visit on Wednesday and a scope of my vocal cords revealed that the granuloma has grown back where it had mostly healed. This is bad news. Because of this, I have no choice but to take an indefinite break from live performing.”

Though I do not know of his particular case firsthand, it is quite unusual for a granuloma to require surgery.  Understanding management of granulomas requires some knowledge of how and why they form.

What is a vocal granuloma?

A granuloma is a growth that occurs on the back of the vocal cords, on an area of exposed cartilage. This is important because it is not a mass on the vocal cord itself.  Therefore, the voice is often normal in cases of early granulomas.  However, as the granuloma enlarges, the voice begins to deteriorate.

The cartilage becomes exposed through voice trauma (i.e., aggressive/loud voice use, excessive voice use, incorrect voice use).  Co-existing medical problems (i.e., acid reflux) make this area of exposed cartilage swell and become inflamed.  This inflammation results in an overgrowth of the lining which eventually forms a granuloma.

See below for a video of a vocal granuloma

Is a vocal granuloma dangerous?

Vocal granulomas are not dangerous unless they become very large.  When they are very large, they may obstruct the airway and cause difficulty breathing.

However, they may cause significant vocal disability, including:

  • Decreased vocal range
  • Change in vocal pitch
  • Pain while speaking/singing
  • Decreased vocal endurance
  • Decreased ability to project

These changes may occur even when the granuloma is small.

What is the treatment of a vocal granuloma?

The most important thing to realize about granulomas is that they rarely need surgery.  Actually, patients who have surgery are more likely to recur than those who are treated with medication alone.  However, appropriate medical management requires a thorough voice evaluation to identify what co-exisiting medical conditions are allowing the granuloma to continue to grow.  For example, acid reflux must be diligently managed to ensure the granuloma can resolve.

However, there are many other factors that must be treated in order to ensure the granuloma resolves and does not recur.  Seeing a laryngologist  allows these factors to be identified and treated.

Will my voice return to normal after treatment?

Because a vocal granuloma does not affect the vibrating edge of the vocal cords, it should not result in direct vocal damage.  This means that when the granuloma is treated completely, your voice should return to normal.

Do I need voice rest as part of my treatment?

As stated above, granulomas begin due to how or how often you use your voice.  Therefore, voice use re-education is often required.  However, total voice rest (i.e., silence) is rarely required.  Working with a specialized voice therapist (not a general speech therapist) and a good vocal coach is critical.  Your laryngologist can refer you to a voice therapist.

For more information about vocal surgery or Dr. Reena Gupta, visit: