ear, nose, and throat disorders
Laryngeal Contact Ulcers
Introduction
Laryngeal contact ulcers are unilateral or bilateral erosions of the mucous membrane over the vocal process of the arytenoid cartilage. ). They may also occur after endotracheal intubation if an oversized tube erodes the mucosa overlying the cartilaginous vocal processes. Cough in Adults and (See also Overview of Laryngeal Disorders .) 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 , 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. 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 