Contact granulomas of the larynx.

Ten cases of intubation granulomas and eight cases of contact granulomas not related to intubation were reviewed for the purpose of clinical analysis and pathological investigation. Granulomas were located primarily at the vocal process of the arytenoid cartilage. Additionally, 58 hemilarynges obtained from 37 cadavers with intubation granulomas were evaluated grossly and histopathologically. The intubation granulomas had no side predilections. All eight contact granulomas occurred in males and had a higher incidence of recurrence (three of eight cases) despite complete removal with laser surgery. In an attempt to explain recurrences of these contact granulomas, all three cases were studied clinically and pathologically. Results indicated that they recurred in singers and vocal abusers, and presumably resulted from the continued hammering of one vocal process against the other. Analysis also demonstrated that vocal rehabilitation was essential prior to or immediately after removal of the granuloma to prevent its recurrence. Pathological evaluation of the contact granulomas revealed focal ulceration and a covering of necrotic tissue with desquamating epithelium. The propria mucosa was edematous and infiltrated by chronic inflammatory cells and neutrophils forming focal granulation tissue in a stroma containing proliferated capillaries. Pathological features around local ulcerations were typical of a secondary granuloma while underlying arytenoid cartilage was partially necrotic.