Das Kontaktgranulom: Symptomatik - Ätiologie - Diagnostik - Therapie

Abstract

Contact ulcer granuloma has a multifactorial etiology but vocal abuse is considered the most important etiological factor. Some other possible factors are well-known: tuberculosis, allergies, hormonal or autonomic imbalance, psychosomatic influences, reflux-esophagitis, pathological conditions of the nose, nasal accessory sinus, tonsils. Constitutional factors play also an important role. The symptoms range from mild huskiness to severe hoarseness with pain extending to the ear, dysphagia, sometimes hemoptysis and chronic cough. Failure to recognize the pathological features of this frequently overlooked lesion leads to diagnosis of larynx cancer, angiosarcoma or hemangioma. Indication for microsurgical removal is only severe dyspnea by size of mass or if the dignity is not clear, because any surgical procedure has only temporary value and does not eliminate the etiological factors. The dignity can normally be proved by stroboscope. Vocal rehabilitation and re-education are an essential appropriate means of treatment for this disease if other causative factors are excluded.

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

“…Recurrence rates of up to 92% are reported [104] despite careful microsurgical excision and cleaning of the perichondrium [105]. We reserve surgery only to exclude malignancy or for obstructing granulomas [106], [107]. …”