[Pathogenetic and therapeutic aspects of contact granuloma]

Contact ulcer and granuloma is an etiologically multifactorial chronic inflammatory disease of the larynx. Besides mechanical laryngeal factors, gastrointestinal and psychosomatic aspects of pathogenesis have been suggested. 51 patients suffering from contact ulcer or granuloma underwent laryngologic and phoniatric examination. In addition, a questionnaire asking for symptoms and habits (smoking, alcohol) was completed by each patient. Subsequent to completing the treatment course, the patients were re-examined. Each patient was examined several times and the success of 6 therapeutic strategies was compared. 49 patients were male and almost 70% complained of private or professional stress. Since only 8% were smokers, smoking habits do not play a pathogenetic role. Drinking habits are also not a significant factor. A striking therapeutic result observed by us was complete remission in more than 80% of patients who had received an acid-inhibiting agent as monotherapy. The remission was higher in this group than in patients treated by logopedic therapy. In case of carcinophobia or if cancer could not be excluded by laryngoscopy and stroboscopy, granulomas were removed surgically. More than 90% of these patients suffered from recurrence unless voice therapy was directly performed. On the other hand, antacid therapy yielded excellent results in patients suffering from recurrent granuloma or ulcer after surgery. We conclude that peptic diseases of stomach and oesophagus play an important role in the pathogenesis of contact ulcer and granuloma and recommend routine interviews and internal examination of patients. Antacid therapy should be firmly installed in the therapeutic strategy against contact ulcer.