Singer John Mayer Has Recurrence of Vocal Cord Granuloma

In September 2011, grammy-award winning singer John Mayer announced the cancellation of a number of concerts as well as an album due to the development of a vocal cord granuloma of his voicebox. Read a blog article about this.

On Oct 20, 2011, he underwent surgery to remove the granuloma and was on strict voice rest for several weeks with plans to resume live singing in the first quarter of 2012.

Unfortunately, on March 9, 2012, it was found that his vocal cord granuloma has recurred in the same location. In a statement he publicly released:

"Because of this, I have no choice but to take an indefinite break from live performing. Though there will be a day when all of this will be behind me, it will sideline me for a longer period of time than I care to have you count down."

 Is this unusual that his vocal cord granuloma recurred?

Unfortunately, it is not...

Vocal cord granulomas are benign masses that commonly are due to repetitive mild vocal trauma resulting in exuberant growth of a specific region of the voicebox lining. An imprecise analogy of what a granuloma is would be a keloid of the skin. Unfortunately, such repetitive mild vocal trauma includes talking/singing, hence the high risk of recurrence. The key to treatment is to allow the granuloma site to heal COMPLETELY prior to any further phonotrauma (ie, talking/singing).

Strict voice rest as well as voice therapy helps as it eliminates the repetitive phonotrauma that promotes regrowth. Reflux control is also essential. However, it is not unusual that steroid injections to the granuloma site as well as even botox injection to partially and temporarily paralyze the vocal cord may need to be pursued for complete resolution. Laser and mitomycin C application has also been found to be helpful.

Surgical removal of the granuloma may have looked something like this video...

To summarize, the steps followed when a granuloma-like mass is discovered on exam is as follows:

1) Trial restricted voice use and reflux medications. Voice therapy also strongly recommended. Strict voice rest is preferred if possible.

2) If no improvement after a period of time, surgical excision to ensure it truly is a granuloma and not cancer or some other pathology

3) Follow-up with steroid injections to the granuloma site. Watch video below.

4) Botox injection can be considered which chemically prevents complete vocal cord adduction preventing the repetitive trauma to the granuloma site.

5) Re-excision may be required at which time mitomycin C application can be tried.

Read more about voicebox granulomas.

Source:

John Mayer's Granuloma Returns, Singer Taking "Indefinite Break From Live Perfoming". E Online 3/9/12

Singer John Mayer Undergoes Vocal Cord Surgery

In September 2011, grammy-award winning singer John Mayer announced the cancellation of a number of concerts as well as an album due to the development of a vocal cord granuloma of his voicebox. Read a blog article about this.

Last week on Thurs, Oct 20, 2011, he underwent surgery to remove the granuloma and is now on strict voice rest for several weeks.

Though removal sounds like a great idea, vocal cord granulomas are notoriously difficult to eliminate completely as they have a high risk of recurrence. Strict voice rest as well as voice therapy helps as it eliminates the repetitive phonotrauma that promotes regrowth. Reflux control is also essential. However, it is not unusual that steroid injections to the granuloma site as well as even botox injection to partially and temporarily paralyze the vocal cord may need to be pursued for complete resolution.

Surgical removal of the granuloma may have looked something like this video...



Read more about vocal cord granulomas here.

Read a NY Magazine article about his surgery.

Singer John Mayer Diagnosed with Vocal Cord Granuloma

On Sept 19, 2011, media reported that singer John Mayer has been forced to cancel all upcoming concert plans and delay release of a new album due to a voicebox growth.

This growth was described as a "granuloma."

What exactly is a granuloma?

It is a benign mass commonly due to repetitive mild vocal trauma resulting in exuberant growth of a specific region of the voicebox lining.

To be more precise, rather than the vocal cord itself, granulomas are most commonly found on the vocal process which is the "hinge" that allows for vocal cord movement. It is located in the back area of the voicebox.

An imprecise analogy of what a granuloma is would be a keloid of the skin.

Symptoms include mild (if any) hoarseness, mild intermittent pain on the side of the voicebox where the granuloma is located with talking/singing, rarely coughing up blood, and if large, shortness of breath.

Just like keloids of the skin, surgical removal alone is almost certainly going to fail with recurrence of the granuloma within weeks to months. All repetitive trauma to the area must be addressed to minimize risk of recurrence which is why restricted voice use must be pursued for several months (no loud talking/singing, talking ONLY when you must). Voice therapy helps to "teach" a person how to talk when they talk without causing further injury to the area. As such, botox injection to the vocal cord has been found helpful to semi-paralyze the vocal cords from coming together (chemically induced vocal cord paralysis). Reflux medications are necessary even if a patient has no symptoms as ANY acid exposure to the area is just as bad a trauma due to yelling.

Steroid injections are helpful to minimize the underlying exuberant inflammatory reaction that leads to granuloma recurrence and may need to be performed several times for effect.

To summarize, the steps followed when a granuloma-like mass is discovered on exam is as follows:

1) Trial restricted voice use and reflux medications. Voice therapy also strongly recommended.
2) If no improvement after a period of time, surgical excision to ensure it truly is a granuloma and not cancer or some other pathology
3) Follow-up with steroid injections to the granuloma site. Watch video below.
4) Botox injection can be considered which chemically prevents complete vocal cord adduction preventing the repetitive trauma to the granuloma site.

Read a Rolling Stone report here.

Read more about voicebox granulomas.