Benign Lesions of Larynx

BENIGN LESIONS OF LARYNX
VOCAL NODULES
  • Singer's or Screamer's nodes
  • Appear symmetrically on the free edges of vocal cords, at the junction of anterior one-third and posterior two-thirds.
  • Size of nodule is less than 3 mm.
  • Results of vocal trauma when a person speaks in unnatural low tones for prolonged periods or at high intensities
  • Mostly affects teachers, actors, vendors and pop singers
  • Also in school going children who are too talkative
  • Symptoms – hoarseness of voice, vocal fatigue and pain in the neck on prolonged phonation.
  • Management:
  1. First line of therapy is speech therapy.
  2. Microlaryngoscopic surgery should be reserved for cases which do not respond to voice therapy.
  3. Small nodules mostly needs conservative management .Large nodules may need surgical excision
VOCAL POLYP
  • Result of vocal abuse or misuse
  • Other factors – allergy and smoking
  • Men in the age group 30-50 are mostly affected
  • Unilateral, at the junction of anterior one-third and posterior two-thirds of vocal cord.
  • Size of polyp is more than 3 mm.
  • Hoarseness is the main symptom
  • Diplophonia (double voice) – different vibratory frequencies of two vocal cords.
  • Treatment is surgical removal of vocal polyp.
  • Speech therapy to prevent further polyp.
CONTACT ULCER
  • The most common site for contact ulcers is vocal processes of the arytenoid cartilage.
  • Contact ulcers: / Vocal process granuloma / arytenoids granuloma / intubation granuloma/contact granuloma/pachyderma laryngitis/kiss ulcer.
  • Nearly exclusively seen in men over the age of 30 years.
  • Commonly located over the posterior part of vocal processes of arytenoid cartilage.
  • Can be unilateral or bilateral
  • It is multifactorial in aetiology:
  • Vocal abuse (most important Etiological factor) talking in a habitually low pitched cracky, hyperfunctional manner 
  1. Prolonged intubation
  2. Adductor dysphonia
  3. Esophageal dysfunction (such as gastroesophageal reflux, hiatus hernia, dysmotility).
  • Symptoms
  1. Low pitch quality of voice (most prominent feature).
  2. Irritation and pain in larynx which worsens on phonation or coughing and it can radiate to ear.
  • Management
  1. Voice therapy along with anti reflux medications.
  2. In persistant cases microlaryngeal excision may be required to confirm the diagnosis and exclude malignancy.
REINKE'S EDEMA
  • Under the epithelium of vocal cords is a potential space with scanty subepithelial connective tissues. It is known as Reinke's space.
  • It is bounded above and below by the arcuate lines; in front, by anterior commissure, and behind by vocal process of arytenoid.
  • Oedema of this space causes fusiform swelling of the membranous cords (Reinke’s oedema).
  • Polypoid degeneration of vocal cords is due to oedema of the subepithelial space.
  • Bilateral symmetrical swelling of the membranous part of the vocal cords is seen.
  • Chronic irritation of vocal cords due to misuse of voice, heavy smoking, chronic sinusitis and laryngopharyngeal reflux are likely to be associated in Reinke's Edema. In Reinke’s oedema hoarseness is the common symptom.
  • Patient uses false cords for voice production and this gives a low pitched and rough voice.
Treatment:
  1. Medical:Voice therapy,Smoking cessation,treatment of URTI,Reflux.
  2. Surgical therapy:Indicated when gross edema causes choking or pitch elevation is required.
Exam Question
  • Vocal nodule is also known as screamer's node and occur at junction of ant. 1/3rd and post. 2/3rd of vocal cords.
  • Reinke's space is situated in edges of True vocal cord.
  • Chronic irritation of vocal cords due to misuse of voice, heavy smoking, chronic sinusitis and laryngopharyngeal reflux are likely to be associated in Reinke's Edema. In Reinke’s edema hoarseness is the common symptom.
  • In Reinke's edema, bilateral symmetrical swelling of the membranous part of the vocal cords is present.
  • In Reinke's edema,Polypoid degeneration of vocal cords is due to oedema of the subepithelial space.
  • The most important cause for contact ulcer in vocal cords is Voice abuse.
  • Contact ulcer can be caused by intubation injury, adductor dysphonia.
  • Contact ulcer can be caused/aggravated by acid reflux
  • Vocal process is the site for contact ulcer formation.
  • Kiss ulcer of larynx is due to Vocal Abuse.

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