Osteosclerosis of the arytenoid cartilage is a hardening or thickening of the cartilage at the back of the voice box. This condition may not be visible on a basic exam, but can be seen on a CT scan. It is most often discovered in patients who have recurrent contact granulomas that don’t improve with treatment. The hardened cartilage can press against the opposite vocal cord and prevent the area from healing properly. Patients with osteosclerosis may feel hoarseness, vocal fatigue, or discomfort on one side of the throat. Because it causes mechanical irritation, even a small area of thickening can lead to repeat trauma with every vocal fold closure. Treatment begins with reflux control and may include steroid injections or antibiotics if there is inflammation. In rare, persistent cases, surgery may be needed to reshape or reduce the thickened cartilage. Recovery depends on the severity of the disease and may include continued voice therapy and close follow-up.