Chronic coughing or throat clearing and acid reflux can cause inflammation and ulceration of the thin mucosa overlying the vocal cords, known as a contact ulcer. A contact ulcer presents as a depressed, ulcerated area with whitish exudate or a bilobed granuloma on the vocal process upon laryngeal examination. Treatment involves modifying voice use to prevent further trauma, antireflux medications, inhaled or intralesional steroids, and microsurgical excision of granulomas as a last resort due to the risk of postoperative recurrence.

1. PRESENTED BY:-
PRATEEK YADUVANSHI
(92)
CONTACT ULCER

2. INTRODUCTION
• Contact granuloma or
ulceration is seen primarily in
men
• Aetiology: Chronic coughing or
throat clearing and reflux of
acid
• The thin mucosa and
perichondrium overlying the
cartilaginous glottis become
inflamed during chronic
coughing or throat clearing.
Acid reflux may also increase
inflammation of the vocal
process area. The traumatized
area ulcerates or produces a
heaped-up granuloma.

3. DIAGNOSIS
• History of Caffeine and alcohol consumption , late-night eating, acid reflux
symptoms.
• Frequent symptoms include unilateral discomfort over midthyroid cartilage,
occasionally referred pain to ear.
• Voice of a patient with contact ulcer or granuloma may sound normal or only
slightly husky.
• Laryngeal Examination : A depressed, ulcerated area with a whitish exudate
or a bilobed, heaped-up lesion on the vocal process.

4. • Surgery should be a last resort
because postoperative
recurrence of the ulcer or
granuloma is predictable.
• Mircrolaryngeal excision of
granuloma Removal should
be limited, leaving
the base or pedicle undisturbed
• Voice modification to
prevent continued
trauma
• Antireflux treatment
• Steroid :- inhaled or
intralesional
TREATMENT
Medical treatment Surgical