Contact Granuloma/Contact Ulcer
Contact granulomas or contact ulcers are formed as a result of injury to the delicate tissues of the larynx. In response to this trauma, the covering tissue of the vocal folds either breaks down, forming a contact ulcer, or produces heaped-up accumulation of tissue, a contact granuloma. These lesions usually appear as a build-up of pinkish-white tissue near the arytenoid cartilages at the rear of the larynx. They differ from vocal cord nodules, which are usually hypertrophic callous.
Contact granulomas occur almost exclusively in men older than 20 — commonly in professional voice users such as lawyers, ministers, business executives and physicians.
Symptoms: The primary symptom of a contact granuloma is the sensation of a foreign body in the throat. Constant and vigorous throat-clearing is often present and, less often, hoarseness or a husky-sounding voice. Pain, usually described as sharp and stabbing, may also be present and may radiate toward the ear.
Causes: The most common cause of contact granulomas is voice misuse — often accompanied by excessive throat-clearing or coughing. These activities cause the vocal folds to "slap" together forcefully, causing trauma to the covering tissue. Acid reflux from the stomach can also cause inflammation of the vocal folds and contribute to granuloma or ulcer formation. A less common cause is direct trauma to the vocal folds, for instance as a result of intubation during surgery.
Treatment: Voice therapy is commonly used as a primary form of treatment. The patient is taught to avoid those behaviors, which may injure the vocal folds. Inhaled corticosteroids are frequently prescibed, along with an anti-acid reflux regimen. Surgery to remove these types of lesions is usually undertaken as a last resort because recurrence is common.