Laryngeal contact ulcers are unilateral or bilateral erosions of the mucous membrane over the vocal process of the arytenoid cartilage.
Laryngeal contact ulcers are usually caused by voice-use trauma in the form of repeated sharp glottal attacks (abrupt loudness at the onset of phonation), often experienced by singers (see The Professional Voice). They may also occur after endotracheal intubation if an oversized tube erodes the mucosa overlying the cartilaginous vocal processes. Chronic cough and gastroesophageal reflux disease (GERD) may also cause or aggravate contact ulcers. Prolonged ulceration leads to vocal process granulomas.
(See also Overview of Laryngeal Disorders.)
Symptoms of laryngeal contact ulcers include varying degrees of hoarseness, globus sensation, and mild pain with phonation and swallowing.
Diagnosis of laryngeal contact ulcers is by laryngoscopy. Biopsy to exclude carcinoma or tuberculosis should be considered.
Treatment of laryngeal contact ulcers requires managing the cause of the ulcers, which may include cough suppression (medical and/or behavioral), treatment of GERD, antibiotic/antifungal therapy, and speech rehabilitative therapy to improve vocal and cough hygiene. Patients should be examined at intervals to observe for healing.
Laryngeal contact ulcers carry a high risk of recurrence. Patients should be counseled that continuation of good vocal health habits is essential.
The Professional Voice
People who use their voice professionally may experience voice disorders manifesting as hoarseness or breathiness, lowered vocal pitch, vocal fatigue, nonproductive cough, persistent throat clearing, and/or throat ache. These symptoms often have benign causes, such as vocal nodules, vocal fold edema, polyps, or granulomas. Such disorders are often caused by voice-use injuries and may be worsened by other conditions such as laryngopharyngeal reflux. Treatment in most cases includes the following:
|
