Granuloma/Contact Ulcer

What is a granuloma?

A granuloma, or contact ulcer, is a benign (non-cancerous) area of inflammation typically located on the back part of the larynx. Contact granulomas may occur bilaterally (both vocal folds) or unilaterally (one vocal fold).

What causes a granuloma?

These lesions are often associated with:

  • Laryngeal intubation injury following surgery or long term airway ventilation
  • Esophageal reflux which is thought to irritate the tissue of the back of the larynx and put this area at higher risk of injury or ulceration (i.e. granuloma or contact ulcer)
  • Vocal misuse/abuse - especially the use of a pressed, loud, low-pitched voice quality

What are the symptoms of a granuloma?

Unless the area of inflammation is large, the presence of a granuloma often does not affect the vibration of the vocal folds and therefore does not significantly impact voice quality. However, many patients complain of:

  • throat pain
  • throat irritation
  • lump in the throat sensation
  • vocal fatigue

How is a granuloma treated?

Typically, the first line of treatment for a granuloma/contact ulcer is medicinal management of reflux. Additionally, patients will be strictly instructed to cease any throat clearing or coughing in order to decrease further irritation of the lesion. Voice therapy may also be beneficial. Voice therapy can help improve voicing patterns to decrease pressure on the posterior portion of the larynx, allowing for healing of the lesion.

These lesions may take many months or even up to a year or two to heal. Surgical management is typically not recommended because the lesions usually return after surgery (often larger than before). However, if medicinal management and behavioral techniques do not improve the lesions or if the lesions are impacting quality of life; in-office lasers, steroids, or last-resort surgical management may be offered or warranted.