Contact granuloma/ulcer

Contact ulcer or contact granulom refer to a lesion that is produced after a trauma or irritation and is commonly located on the posterior third of the vocal fold. Granuloma of the larynx can be categorized broadly into two—specific and nonspecific. Specific ones are infrequent and include those that are infectious in origin such as granulomas caused by tuberculosis. The second type or nonspecific ones are benign and may occur unilaterally or bilaterally.
Patients usually are men greater than 20 years of age and are usually into professions that use voice a lot such as lawyers and ministers. ^{[1] [2]}

Causes

Voice misuse is the most frequent cause. This can be worsen by too much clearing of throat or coughing. Shouting and talking loudly for extended periods of time are also thought to account for some cases.

Direct trauma may also cause contact ulcers or granuloma such as in intubation, a process done in surgeries. Acid reflux can also contribute to the inflammatory process. Factors that may contribute to acid reflux are caffeine, alcohol, cigarette smoking, high intake of fatty foods, obesity and pregnancy. ^{[2] [3]}

Signs and Symptoms

When the ulcer or granuloma is located on only one side, the patient can feel minimal to no symptoms. Frequently, granuloma causes the affected person a feeling of lump in the throat. Hoarseness and voice breaks are also common symptoms. The patient can have a reduced pitch range, pressed voice quality, frequent throat clearing, coughing, bitter taste in the mouth and pain. ^{[1] [3] [4]}

Diagnosis

After obtaining the medical history of the patient especially after identifying the risk factors and after performing a physical examination, the patient is often asked to undergo laboratory tests. Among the tests available are pH tests, flexible nasopharyngoscopy, objective voice measurements, electromyography, speech therapy evaluation and videostrobolaryngospcopy. ^[1]

Treatment

Antireflux medications such as omeprazole may be given. Depending on the necessity, the patient may be given cough suppressant or steroid therapy. Lifestyle modifications are crucial. These include avoidance of foods and drinks that trigger acid reflux and correction of voice behaviors like habitual talking in a loud voice. When these measures fail, surgery is recommended. ^[1]

References:

1.      http://emedicine.medscape.com/article/865924-overview

2.      http://www.intelihealth.com/IH/ihtIH/E/35263/35278/196410.html?d=dmtContent

3.      http://voicehealth101.com/topics/granulomas

http://www.voicemedicine.com/granuloma.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Pau D'Arco (Lapachol, Tabebuia Impetiginosa, Tabebuia Heptaphylla) [1, 5]:

Please note, this treatment has potentially serious side effects. Some of the chemicals in the plant are known to be toxic. High doses are known to cause liver and kidney. Even at low doses, chemicals in the plant may interfere with blood clotting, causing excess bleeding and anaemia. Pau D'Arco should be avoided, especially by pregnant or breastfeeding women.

Recommendation: Strongly against (There is insufficient evidence to support claims that Pau D'arco helps to treat ulcers. This, combined with its potentially harmful side effects if taken without supervision from a doctor or pharmacist gives enough reason to avoid this treatment.)

Grade of Evidence: very low quality of evidence

Comfrey (Blackwort, Symphytum Officinale)  [1, 2, 3, 4]:

Please note, this herb is TOXIC IF TAKEN ORALLY, OR IF APPLIED TO AN OPEN WOUND. Can cause severe liver or kidney damage and lead to death. May ONLY be used as a cream over intact skin, and does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Strongly Against  (ONLY TO BE USED AS A CREAM OVER HEALTHY SKIN. If used over a wounded or ulcerative area, it can be absorbed into the body)

Grade of Evidence: low quality of evidence

Arnica Root (Arnica Montana):

Recommendation: no recommendation (available evidence shows that Arnica is in no way helpful in the treatment of contact ulcers)

Grade of Evidence: moderate quality of evidence

Hyperbaric Oxygen Therapy (HBOT):

Recommendation: Strongly against (available evidence shows that HBOT is in no way useful in treating Contact Ulcers, and can have harmful effects. NOT RECOMENDED)

Grade of Evidence: low quality of evidence

Low-Level Laser Therapy:

Recommendation: no recommendation (there is insufficient evidence to show that laser therapy is helpful in treating contact ulcers)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.ncbi.nlm.nih.gov/pubmed/19460762

3. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/comfrey

4. http://www.ncbi.nlm.nih.gov/pubmed/2103401

5. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pau-d-arco