MCQ – 96853

A 45-year-old teacher presents to the physician with complaints of hoarseness and voice fatigue. She reports that these symptoms have been gradually worsening over the past few months, especially towards the end of the school day.She denies any history of smoking or excessive alcohol consumption. Flexible laryngoscopy image is given below. what is the diagnsosis?

Correct Answer » A Explanation

• The laryngoscopic image shows:
  • Bilateral, symmetrical, small whitish swellings on the free edge of both vocal cords.
  • The lesions are located at the junction of the anterior one-third and posterior two-thirds of the true vocal cords.
  • The lesions are paired (“kissing nodules”), which is characteristic of vocal nodules.

• The patient is a teacher, a classic example of a professional voice user.
• She has:
  • Progressive hoarseness.
  • Voice fatigue.
  • Symptoms worsening after prolonged voice use.
• These features strongly suggest phonotrauma, leading to vocal nodules.

Explanation of the Correct Answer

• Vocal nodules are benign lesions caused by chronic voice abuse or misuse.
• They occur due to repeated trauma at the point of maximum vibration of the vocal cords.
• They are typically:
  • Bilateral.
  • Symmetrical.
  • Located at the junction of the anterior one-third and posterior two-thirds of the vocal cords.
• They are commonly seen in:
  • Teachers.
  • Singers.
  • Public speakers.
  • Call-center workers.

Why Other Options are Incorrect

B. Reinke’s edema

• Characterized by diffuse, gelatinous swelling of the entire membranous vocal cords.
• Usually associated with:
  • Smoking.
  • Hypothyroidism.
  • Chronic laryngopharyngeal reflux.
• The image does not show diffuse edema.

C. Vocal polyp

• Usually unilateral.
• Larger than vocal nodules.
• May be pedunculated or sessile.
• Often develops after acute vocal trauma.
• The image shows bilateral symmetrical lesions, making a polyp unlikely.

D. Keratosis of the larynx

• Appears as irregular white plaques (leukoplakia) over the vocal cords.
• Strongly associated with:
  • Smoking.
  • Premalignant changes.
• The image does not show diffuse leukoplakia.