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Laryngeal Contact Ulcers

by Clarence T. Sasaki, MD

Laryngeal contact ulcers are unilateral or bilateral erosions of the mucous membrane over the vocal process of the arytenoid cartilage.

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 (see Vocal Cord Polyps, Nodules, and Granulomas).

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

Diagnosis is by laryngoscopy. Biopsy to exclude carcinoma or TB is important.

Treatment consists of ≥ 6 wk of voice rest. Patients must recognize the limitations their voice and learn to adjust their postrecovery vocal activities to avoid recurrence. Risk of recurrence is reduced through vigorous treatment of gastroesophageal reflux (see Gastroesophageal Reflux Disease (GERD) : Treatment). Suppression of bacterial flora with antibiotics is also recommended.

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