Merck Manual

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Laryngeal Contact Ulcers


Hayley L. Born

, MD, MS, Columbia University

Reviewed/Revised Mar 2023
Topic Resources

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 ). They may also occur after endotracheal intubation if an oversized tube erodes the mucosa overlying the cartilaginous vocal processes. Chronic cough Cough in Adults Cough is a protective reflex that prevents aspiration and expels particles and irritants from the airway. However, it can become uncontrolled or disabling and is one of the most common symptoms... read more and gastroesophageal reflux disease The Professional Voice The Professional Voice (GERD) may also cause or aggravate contact ulcers. Prolonged ulceration leads to vocal process granulomas Vocal Cord Polyps, Nodules, and Granulomas Acute trauma or chronic irritation causes changes in the vocal cords that can lead to polyps, nodules, or granulomas. All cause hoarseness and a breathy voice. Persistence of these symptoms... read more Vocal Cord Polyps, Nodules, and Granulomas .

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 Treatment Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing burning pain. Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia... read more Treatment , 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:

  • Voice evaluation by a speech pathologist or experienced physician, including, when available, use of a computer-assisted program to assess pitch and intensity and to determine parameters of vocal acoustics

  • Behavioral treatment (decreasing musculoskeletal laryngeal tension when speaking) using a computer program for visual and auditory biofeedback

  • A vocal hygiene program to eliminate vocally abusive behaviors, such as excessive loudness, long duration (continuous speech for > 1 hour), vocal tension (excessive muscular strain during phonation), and habitual throat clearing

  • An antireflux regimen, when appropriate

  • Adequate hydration to promote an adequate glottal mucosal wave

  • Diet and behavioral modification before vocal performances, which may include avoidance of alcohol, caffeine, and ambient tobacco smoke and other inhaled irritants

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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