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Contact Granuloma

Otolaryngology

Contact Granuloma also known as Vocal Granulomas, is a common lesion in the throat that primarily occur on the mucous membrane at the back of the vocal cords. These ulcers result from chronic injury caused by repeated pressure and friction in the areas where the vocal cords come into contact.

Symptoms

Typical symptoms of contact ulcers include:

Hoarseness: The ulcers affect the normal vibration of the vocal cords, leading to a hoarse voice.
Coughing: An irritating cough may be, especially after speaking or laughing.
Throat pain or discomfort: Patients might feel throat pain or a sensation of a foreign body, especially after speaking for long periods.
Pain during swallowing: There may be pain or discomfort in some cases

Causes

Contact ulcers are related to repeated pressure and injury to the vocal cords. These ulcers typically occur at the contact points of the vocal cords, where they frequently rub together during speaking or vocalizing, leading to chronic irritation and damage. Common causes of contact ulcers include:

Overuse of vocal cords:
Prolonged use of the voice, especially at high intensity or with improper vocal techniques, can subject the mucous membrane at the back of the vocal cords to repeated pressure and friction, leading to ulcers.
Poor vocal techniques:
Incorrect vocal techniques (such as forceful coughing, loud shouting, etc.) can increase the pressure at the points where the vocal cords contact, resulting in mucosal damage.
Mechanical irritation of the vocal cords:
Certain professions that require extensive speaking, such as teachers, public speakers, and singers, may experience excessive mechanical irritation of the vocal cords due to the nature of their work.
Intubation trauma:
Prolonged or frequent tracheal intubation, especially during surgeries and intensive care, can cause physical irritation or pressure on the back of the vocal cords, leading to ulcers.

Risk Factors

The formation of contact ulcers is influenced by various risk factors, including:

Occupational factors: Individuals in professions that require intense or sustained voice use, such as teachers, lawyers, actors, and salespeople, are at higher risk.
Poor lifestyle habits: Smoking can directly irritate and damage the vocal cords, increasing the risk of ulcer formation.
Vocal cord fatigue: Individuals who do not give their vocal cords adequate rest over long periods may have an increased risk of developing ulcers.
Gastroesophageal reflux: Acid reflux reaching the throat can cause additional chemical irritation, damaging the vocal cords and indirectly promoting ulcer formation.
Inflammation and infection: Chronic inflammation or infections in the throat can increase the risk of ulcers, making the vocal cords more susceptible to damage.

Diagnosis & Treatments

Diagnostic Methods

Laryngoscopy

Direct Laryngoscopy: The doctor uses a small mirror placed at the back of the throat to observe the vocal cords and internal structure directly.

Fiberoptic Laryngoscopy: This more advanced examination involves a thin, flexible fiberoptic laryngoscope inserted through the nostril to observe the vocal cords and throat structures. The doctor can view the dynamic movements of the vocal cords during speech or phonation.

Biopsy

The doctor may occasionally remove a small tissue sample (biopsy) for examination under a microscope to ensure the ulcer is not cancerous (malignant) or caused by tuberculosis.

Stroboscopy

Stroboscopy can reveal surface abnormalities such as ulcers or granulomas and assess the function and vibration patterns of the vocal cords by using a strobe light to capture the details of vocal cord vibrations.

Treatment Methods

The primary treatment for vocal cord contact ulcers is reducing vocalization and providing at least six weeks of rest for the vocal apparatus to allow the ulcers to heal. It is crucial to note that even whispering can cause further vocal cord damage and should be avoided.
To prevent the recurrence of vocal cord contact ulcers, patients should undergo professional voice therapy. A speech therapist will guide patients on proper voice usage and help them learn healthy vocal techniques.
Additionally, for ulcers caused by gastroesophageal reflux, treating acid reflux is essential for ulcer healing. Patients are advised to take antacid medications, avoid eating within two hours before bedtime, and elevate the head of the bed while sleeping to reduce night-time reflux.
During the healing process, using antibiotics can prevent potential bacterial infections, further protecting the vocal cords from infection threats. This comprehensive approach helps effectively treat and prevent the recurrence of vocal cord contact ulcers.