Mucosal ectasia (dilated blood vessels on the vocal fold surface) and contact granuloma (a benign reactive growth on the vocal process) are two distinct disorders that share a common feature: they appear at specific anatomical locations on the vocal fold and are closely linked to voice use patterns and laryngopharyngeal reflux.
Mucosal Ectasia
What Is It?
Ectasias are abnormally dilated blood vessels visible on the surface of the vocal fold under endoscopy — particularly with stroboscopy or narrow-band imaging (NBI). They appear as reddish streaks or focal red spots on the superior or inferior surface of the fold. They are seen almost exclusively in vocal overdoers and often coexist with nodules or polyps.
Why Does It Matter?
An ectatic vessel on the vocal fold surface is fragile. Vigorous voice use can cause it to rupture, producing a vocal hemorrhage — a sudden, painless loss of voice. This is a laryngologic emergency: the patient must stop all voice use immediately and be seen promptly. Most hemorrhages resorb completely with voice rest, but some organize into a polyp or a scar.
Treatment
Small ectasias without hemorrhage are monitored. A pulsed-KTP laser can be used to coagulate the abnormal vessel in the office under topical anesthesia — a brief, well-tolerated procedure that significantly reduces the risk of hemorrhage.
Contact Granuloma
What Is It?
A contact granuloma is a reactive, benign growth that forms on the vocal process of the arytenoid cartilage — the very back of the vocal fold where the cartilage contacts the opposite cartilage during forceful voice use. It is not a true granuloma histologically but rather granulation tissue — reactive fibrous overgrowth from repeated trauma.
Causes
- Laryngopharyngeal reflux (LPR) — acid irritating the posterior larynx
- Forceful hard glottal attack — slamming the vocal processes together
- Post-intubation trauma from an endotracheal tube
- Vocal overdoers with an abrupt, effortful attack
Symptoms
- Sensation of something in the throat (globus)
- Throat clearing
- Mild hoarseness or voice fatigue
- Occasionally pain radiating to the ear on the affected side
Treatment
Contact granuloma is notoriously recurrent after surgical removal alone. Treatment therefore focuses on the underlying cause: aggressive reflux management, elimination of hard glottal attack through voice therapy, and proton pump inhibitor therapy. Surgery is reserved for large granulomas causing significant symptoms, and should be combined with ongoing reflux and voice treatment to prevent recurrence.