 In addition, the presence of the contact granuloma makes it impossible for the vocal folds to come to a complete closure in adduction.This causes the person to use more force when speaking in an attempt to close the vocal folds completely, which in turn creates more trauma to the vocal folds.Glottal insufficiency (when the vocal folds cannot close completely, often due to vocal fold paralysis) can also be an underlying cause of contact granulomas.