A 30-year-old man complains of hoarseness with pain radiating to the right ear after a difficult intubation 3 months ago. Microlaryngoscopy shows a smooth, ulcerated mass over the vocal process of the right arytenoid. Initial management should be:

• A Wide local excision with CO2 laser immediately
• B Proton pump inhibitor therapy with voice therapy and correction of abusive phonatory habits ✓
• C Injection augmentation of the ipsilateral vocal cord
• D Radiotherapy to the larynx

Explanation

This is a vocal process granuloma (contact ulcer), arising over the thin perichondrium of the vocal process of the arytenoid. Intubation trauma, laryngopharyngeal reflux and hard glottal attack are the usual drivers, and referred otalgia occurs via the vagus. Medical therapy with proton pump inhibitors, voice therapy and habit modification resolves most lesions. Surgical excision alone carries a high recurrence rate unless the underlying cause is corrected, so it is reserved for refractory cases.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.