We are aiming from our study to compare the results of vocal process granulomas treated with inhaled steroids and surgical treatment. Intubation granuloma of the larynx is induced by endotracheal intubation, mainly managed by conservative medical treatment with observation. If no response to medical treatment surgical excision can be considered as a last line of treatment due to the reported recurrence with subsequent repeated surgeries and exposure to anesthesia. 30 granulomas were diagnosed in 24 patients: 6 bilateral and 18 unilateral. 15 granulomas in 12 patients in group A were treated with Steroid inhalation. 1 (6.6%) did not respond, 4 (26.6%) partially responded, and 10 (66.6%) completely responded, No cases had recurrence. In group B which treated surgically, of the 15 granulomas, 15 (100%) removed completely by micro laryngeal cold instruments. Partial recurrence occurred in 2 patients unilateral after 10 weeks 13.3%. Considerable recurrence has been developed in 3 more patients (unilateral) beside the first 2 granulomas (5 Granulomas) 33.3% recurrence after 50 weeks follow up. We advise to manage intubation granuloma of the larynx mainly by inhaled steroid as a first line of treatment.