PATHOGENETIC AND THERAPEUTIC ASPECTS OF L ARYNGEAL CONTACT GRANULOMA

Contact ulcer and granuloma is an etiologically multifactorial chronic inflammatory disease of the larynx. Besides mechanical laryngeal fact ors, gastrointestinal and psychosomatic aspects of pathogenesis have b een suggested. 51 patients suffering from contact ulcer or granuloma u nderwent laryngologic and phoniatric examination. In addition, a quest ionnaire asking for symptoms and habits (smoking, alcohol) was complet ed by each patient. Subsequent to completing the treatment course, the patients were re-examined. Each patient was examined several times an d the success of 6 therapeutic strategies was compared. 49 patients we re male and almost 70% complained of private or professional stress. S ince only 8% were smokers, smoking habits do not play a pathogenetic r ole. Drinking habits are also not a significant factor. A striking the rapeutic 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 lo gopedic therapy. In case of carcinophobia or if cancer could not be ex cluded by laryngoscopy and stroboscopy, granulomas were removed surgic ally. More than 90% of these patients suffered from recurrence unless voice therapy was directly performed. On the other hand, antacid thera py yielded excellent results in patients suffering from recurrent gran uloma or ulcer after surgery. We conclude that peptic diseases of stom ach and oesophagus play an important role in the pathogenesis of conta ct ulcer and granuloma and recommend routine interviews and internal e xamination of patients. Antacid therapy should be firmly installed in the therapeutic strategy against contact ulcer.