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Laryngeal Contact Ulcers

By Clarence T. Sasaki, MD, The Charles W. Ohse Professor of Surgery and Director, Yale Larynx Lab, Yale University School of Medicine

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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 abuse in the form of repeated sharp glottal attacks (abrupt loudness at the onset of phonation), often experienced by singers. They may also occur after endotracheal intubation if an oversized tube erodes the mucosa overlying the cartilaginous vocal processes. Gastroesophageal reflux may also cause or aggravate contact ulcers. Prolonged ulceration leads to nonspecific granulomas.

Symptoms of laryngeal contact ulcers include varying degrees of hoarseness and mild pain with phonation and swallowing.

Diagnosis of laryngeal contact ulcers is by laryngoscopy. Biopsy to exclude carcinoma or TB is important.

Treatment of laryngeal contact ulcers consists of ≥ 6 wk of voice rest. Patients must recognize the limitations of their voice and learn to adjust their post-recovery vocal activities to avoid recurrence. Suppression of bacterial flora with antibiotics is also recommended.

Risk of recurrence is reduced through vigorous treatment of gastroesophageal reflux.

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