Merck Manual

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Laryngeal Contact Ulcers

By

Clarence T. Sasaki

, MD, Yale University School of Medicine

Last full review/revision Jul 2020| Content last modified Jul 2020
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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 (see The Professional Voice). 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 tuberculosis is important.

Treatment of laryngeal contact ulcers consists of ≥ 6 weeks 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.

The Professional Voice

People who use their voice professionally for public speaking and singing often 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 usually caused by vocal fold hyperfunction (excessive laryngeal muscular tension when speaking) and possibly gastroesophageal 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

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