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:

• First line of therapy is speech therapy.
• Microlaryngoscopic surgery should be reserved for cases which do not respond to voice therapy.
• 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 
• Prolonged intubation
• Adductor dysphonia
• Esophageal dysfunction (such as gastroesophageal reflux, hiatus hernia, dysmotility).

Symptoms

•  Low pitch quality of voice (most prominent feature).
•  Irritation and pain in larynx which worsens on phonation or coughing and it can radiate to ear.

 Management

• Voice therapy along with anti reflux medications.
•  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:

• Medical:Voice therapy,Smoking cessation,treatment of URTI,Reflux.
• 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.