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Objective: To assess the clinical profile, presentation, prognosis, and response to treatment of patients with posterior glottic lesions and the prevalence of malignancy in this group., Study Design: Retrospective cohort., Methods: Studying medical records, videostroboscopic examinations, and pathologic reports of patients diagnosed and treated between 2008 and 2011., Results: Forty-six patients had lesions limited to the posterior glottis. Forty-one of the cases were diagnosed clinically or pathologically as inflammatory granulation tissue; three were cysts; one carcinoma in situ; and one invasive squamous cell carcinoma. Of the inflammatory granulation patients, 71% had lesions defined as spontaneous and 29% were considered iatrogenic. Reflux symptoms and reflux signs, as well as psychological stress were significantly more prevalent in the spontaneous group. Fifty percent of the patients with spontaneous lesions had psychological stress, compared with 8% in the iatrogenic group (P value = 0.009). Smoking was a significant risk factor in the iatrogenic group (54% vs 21% P value = 0.03). Nine percent of the lesions were treated with primary surgery. Ninety-one percent were treated with primary conservative management, of whom 31% were eventually referred to surgery. Overall, 91% of the patients were treated successfully. All cases of iatrogenic lesions responded to conservative management or a single surgical intervention. All patients that required multiple interventions were spontaneous., Conclusions: The results of this study suggest that only a small percent of posterior glottic lesions are malignant, thus the decision about biopsy should be based on clinical judgment. Also, spontaneous granulomas are more refractory to treatment, which can be explained by the repetitive exposure to the etiologic factors., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)