Granuloma/Contact Ulcer
Granulomas are highly vascular lesions that develop as the result of tissue irritation in the back part larynx at a place called the vocal process of the arytenoid cartilage. These lesions are often associated with three predisposing conditions:
- Esophageal reflux - which is thought to irritate the tissues of the posterior larynx and predispose this area to injury or ulceration (e.g., contact ulcer).
- Laryngeal intubation (placement of a tube in your airway to help you breathe) injury following surgery or for long term airway ventilation.
- Associated with persistent voice misuse, especially the use of a pressed, low-pitched voice quality.
Reflux
Unless the lesion is quite large, the presence of a granuloma does not affect the vibration of the vocal fold. However, many patients complain of "throat" pain, restricted pitch ranges, and voice fatigue. Typically, medical management of reflux is the first line of treatment for a granuloma and contact ulcer. If medical treatment does not resolve the granuloma, then surgery may be considered. However, granulomas are known to be persistent lesions that often recur. Because the lesion is located in an area of constant movement and mechanical pressure during vocal fold adduction, the potential for chronic irritation and recurrence is high. Voice rehabilitative therapy must include a reduction of the medial compression of the vocal folds, and long-term compliance with anti-reflux behaviors.