Background and Objectives : The vocal fold granuloma has been associated with vocal abuse, gastroesophageal reflux, endotracheal intubation and habitual throat clearing etc.. Granuloma is benign growth of hypertrophic granulation tissue. It is usually located on the posterior third of vocal fold, in one or both vocal process of the arytenoid cartilage In spite of the voice therapy, steroid therapy, anti-reflex therapy and surgical procedure. The distinct advantage and uniform success rate of each methods have not been generally shown. Authors report that localized injection of botulinum toxin type A (BOTOX$^{circledR}$) is the promising method both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates. Materials and Method : We carried out a retrospective study of 9 patients with the diagnosis of vocal fold granuloma on the videostroboscopic examination from Jan 2000 to Mar 2003. The botulinum toxin type A was injected into one or both thyroarytenoid muscle or lateral cricoarytenoid muscle under the electromyography. The average dosage ranges from 6U to 8U per injection. Results : Unilateral vocal fold granuloma in 7 patients had been resolved completely within 2-3 months after first injection : 5 patients received thulcorner GER medical therapy in addition to the Botulinum toxin injections, 2 patients was resolved completely who had shown recurrence after $CO_2$ laser vaporization. 2 patients who had shown recurrence after $1^st$ injection were also completely resolved within 6 months after further injections. Conclusion : We expect that localized injection of Botulinum toxin type A can provide an alternative treatment for the refractory cases to the traditional forms of therapy and avoid the recurrence in conjunction with proper medical and voice therapy against GER and vocal abuse.