Contact Granulomas Workup

Updated: May 15, 2018
  • Author: James D Garnett, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Other Tests

See the list below:

  • Double-pH probe (24 h)

    • This test is performed to determine whether reflux is the cause or merely a contributing factor in the formation or propagation of the contact ulcer.

    • The test can also evaluate the efficacy of treatment.

    • Proton pump inhibitor resistance has been reported.

    • The test may help select those who will benefit from Nissen fundoplication.

  • Pharyngeal pH probe (24 h) [5]

    • This is a newer technology that allows direct measurement of pharyngeal pH.

    • A single channel probe is placed at about the level of the distal tip of the uvula.

    • This allows for direct measurement of acidity, as well as timing of acidity, to help with appropriate therapy.


Diagnostic Procedures

See the list below:

  • Flexible nasopharyngoscopy

    • Always perform visualization of the larynx with a mirror, flexible, or rigid scope. Evidence of laryngeal hyperfunction, muscular tension, and reflux disease may be found, and treatment progress can be followed.

    • The flexible scope allows evaluation of the dynamic activity of the larynx without the distortion of the supraglottic structures that occurs when the tongue is pulled anteriorly during a mirror and rigid telescopic examination.

  • Disadvantages of the flexible scope

    • Reduced detail resolution compared to the mirror or rigid scope

    • Red bias of the flexible scope's color scale

    • Fish-eye distortion of structures

    • Newer "chip-end" flexible scopes offer excellent resolution without the above disadvantages, but the scope can be quite costly and require a specially camera processor to be coupled with a monitor.

  • Videostrobolaryngoscopy

    • The vocal folds vibrate at about 250 hertz (Hz) while phonating a middle C note. The stroboscopic light captures different points on consecutive cycles of phonation, allowing a visual slow-motion study of the larynx in action.

    • The examination is captured on videotape or computer disc for review and study. Subtle, but important, abnormalities that are missed under ordinary light can be observed.

    • The examinations are catalogued and can be reviewed or recalled for future comparison to monitor treatment success or disease progress.

    • This procedure can be performed with both rigid and flexible scopes.

  • Objective voice measurements

    • Allows objective data regarding vocal pitch and perturbation parameters

    • Helps assess treatment results and confirms perceived changes

    • May allow modification of therapy based on parameters in patients who are not responding to the current regimen

    • Noninvasive

  • Electromyography

    • Useful to confirm vocal fold paresis as a predisposing factor toward laryngeal hyperfunction

    • Crucial aid in the instillation of botulinum toxin

  • Speech therapy evaluation

    • Evaluation provides thorough assessment of the vocally abusive behaviors of the patient that contribute to the formation and propagation of the contact ulcer.

    • Factors such as poor breath support, hard glottal attack, improper pitch placement, and other functional issues may be elucidated, thereby facilitating recommendations of proper treatment strategies.

  • If the lesion appears irregular or suspicious for carcinoma in any way, perform a diagnostic laryngoscopy with biopsy.


Histologic Findings

Contact ulcers resemble pyogenic granulomas. Primarily, the ulcers consist of granulation tissue with edema and chronic inflammatory infiltration, neovascularization, and fibrosis covered by squamous epithelium or an ulcerated surface.