Contact granuloma

A type of laryngeal granuloma

Contact granuloma, also known as vocal process granuloma, is a benign lesion that occurs on the vocal cords or the larynx. These lesions are typically found on the posterior third of the vocal cords, near the vocal processes of the arytenoid cartilage. Contact granulomas are often associated with vocal abuse, gastroesophageal reflux disease (GERD), or intubation.

Pathophysiology

Contact granulomas form as a result of chronic irritation or trauma to the vocal processes. The repeated contact and friction between the vocal processes during phonation can lead to inflammation and the formation of granulation tissue. This tissue is characterized by the proliferation of fibroblasts and the infiltration of inflammatory cells, leading to the development of a granuloma.

Causes

• Vocal abuse: Excessive or improper use of the voice, such as shouting or speaking for extended periods, can lead to the formation of contact granulomas.
• Gastroesophageal reflux disease (GERD): Acid reflux can irritate the laryngeal mucosa, contributing to the development of granulomas.
• Intubation: Prolonged or traumatic intubation can cause mechanical irritation to the vocal processes, resulting in granuloma formation.

Symptoms

Individuals with contact granulomas may experience a variety of symptoms, including:

• Hoarseness or changes in voice quality
• Throat pain or discomfort
• A sensation of a lump in the throat
• Chronic cough
• Difficulty swallowing

Diagnosis

Diagnosis of contact granuloma is typically made through a combination of patient history, physical examination, and laryngoscopy. During laryngoscopy, a flexible or rigid scope is used to visualize the larynx and vocal cords, allowing for the identification of any lesions or abnormalities.

Treatment

Treatment of contact granulomas may involve a combination of medical and surgical approaches:

• Voice therapy: Working with a speech-language pathologist to modify vocal habits and reduce strain on the vocal cords.
• Medical management: Addressing underlying conditions such as GERD with medications like proton pump inhibitors.
• Surgical intervention: In cases where conservative measures fail, surgical removal of the granuloma may be necessary.

Prognosis

The prognosis for individuals with contact granulomas is generally good, especially with appropriate treatment. However, recurrence is possible, particularly if the underlying causes are not addressed.

Prevention

Preventive measures include:

• Avoiding vocal abuse and maintaining good vocal hygiene
• Managing GERD with lifestyle changes and medications
• Ensuring careful and atraumatic intubation techniques

Related pages

• Laryngitis
• Vocal cord nodules
• Gastroesophageal reflux disease

Illustration of the larynx showing the location of contact granulomas