Granuloma/Contact Ulcer

Granulomas are highly vascular lesions that develop as the result of tissue irritation in the
back part larynx at a place called the vocal process of the arytenoid cartilage. These lesions
are often associated with three predisposing conditions:
1. Esophageal reflux - which is thought to irritate the tissues of the posterior larynx and
predispose this area to injury or ulceration (e.g., contact ulcer).
2. Laryngeal intubation (placement of a tube in your airway to help you breathe) injury
following surgery or for long term airway ventilation.
3. Associated with persistent voice misuse, especially the use of a pressed, low-pitched
voice quality.
Unless the lesion is quite large, the presence of a granuloma does not affect the vibration of
the vocal fold. However, many patients complain of "throat" pain, restricted pitch ranges, and
voice fatigue. Typically, medical management of reflux is the first line of treatment for a
granuloma and contact ulcer. If medical treatment does not resolve the granuloma, then
surgery may be considered. However, granulomas are known to be persistent lesions that
often recur. Because the lesion is located in an area of constant movement and mechanical
pressure during vocal fold adduction, the potential for chronic irritation and recurrence is
high. Voice rehabilitative therapy must include a reduction of the medial compression of the
vocal folds, and long-term compliance with anti-reflux behaviors.