Also called "contact ulcers", granulomas are discrete (clearly-defined) lesions that occur on the back portion of the vocal fold where it attaches to the arytenoid cartilage. Laryngopharyngeal reflux (LPR) is the most common cause of formation of a granuloma. Another common cause is irritation from an endotracheal tube (the tube placed in the throat for breathing during a surgery under general anesthesia), which can rub against the back of the larynx.
Treatment for granuloma depends upon the size of the lesion and the length of time it has been present, but most likely will require control of reflux, and may also include relative voice rest, and/or surgery and voice therapy. Surgery by itself, without other measures, will often result in the regrowth of the lesion in a short period of time.
The vocal fold on the right side of the picture has a granuloma attached to the vocal process (top of picture).
The posterior vocal process on the left side of this picture has a large granuloma, which causes painful phonation and swallowing for this patient.
The granuloma seen on the left side of this photo is causing a small reactive lesion on the opposite vocal process.