Larynx Inflammatory Lesions

Contact Ulcer/Kissing Ulcer

• Causes of Contact Ulcer/Kissing Ulcer
  • Voice abuse
  • Reflux
  • Sometimes hypertrophic epithelium on one side can cause an ulcer on the other side and there is no true breach in the epithelium, therefore it is called a pseudo ulcer.
• The differential diagnosis includes tuberculosis and carcinoma.
  • On histopathological examination, hyperkeratosis and acanthosis are observed. But it is not a pre-malignant condition.
• Treatment-
  • Patients should be advised to take more and more voice rest.
  • Anti-reflux therapy should be initiated.
  • If the lesion is still there and is not improving then laser excision of the lesion should be an option.

Keratosis Larynx/Leukoplakia

• Caused by
  • Smoking
  • Tobacco chewing
  • Chronic irritation
  • Due to excessive voice abuse 
  • Due to reflux
• The differential diagnosis includes Candidiasis and Carcinoma. It is a pre-malignant condition and the diagnosis can be confirmed with the help of a histopathological examination.
• Treatment is done by excisional biopsy and stripping of the vocal cord.

Vocal Nodule

• It is also called a singer’s or screamer’s nodule.
• The main cause of vocal nodules is chronic vocal abuse and it is mostly bilateral and symmetrical.
• The most common location of focal nodule is at the site of maximum vibration which is at the junction of anterior 1/3 and posterior 2/3^rd.
• The nodule is reddish in the early stage but later it becomes white in the chronic stage. Most of the vocal nodules are sessile.
• The patient will present with hoarseness of voice and vocal fatigue.
• For treatment, the patient will be advised initially to take voice rest but if it still fails to resolve the vocal nodule then microscopic excision without injuring the vocal ligament should be done.

Also Read: Laryngeal Trauma and Laryngotracheal Stenosis

Vocal Polyp

• The main cause of vocal polyps is sudden vocal abuse like shouting.
• It is mostly unilateral in appearance.
• This location of the vocal polyp is similar to the vocal nodule that is the junction of anterior 1/3^rd and posterior 2/3^rd.
• Vocal polyps are pedunculated in structure.
• The patient will present with hoarseness of voice and diplophonia. Diplophonia means double voice due to the different vibrating frequencies of two vocal codes.
• Treatment is microscopic excision of the polyp.

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Laryngeal Papillomas

These are caused by HPV 6 and HPV 11. It has been found that HPV 11 is more aggressive than HPV 6. There are two types of papillomas-

1. Juvenile-onset laryngeal Papillomatosis 
   • These occur mainly in infants and young children age group.
   • The mode of transmission is from mother to child during vaginal delivery.
   • These are multiple in number and can be located anywhere on the larynx.
   • The patient will present with a change in voice, airway obstruction, respiratory distress, and stridor.
   • The papillomas are managed by excision.
   • These papillomas are very aggressive and can come back after excision.
2. Adult-onset laryngeal papillomatosis
   • These occur in mainly 30 to 50 years of age
   • These are twice as common in males and the mode of transmission is sexual.
   • The papilloma is single in appearance and commonly seen on the anterior half of the vocal cord.
   • The patient will present with a change in voice, airway obstruction, respiratory distress, and Stridor.
   • This type of papilloma is less aggressive and after excision, it will not recur.

The diagnosis of laryngeal papilloma is mainly done by histopathology examination. The mainstay of treatment is surgery (microdebrider). Antivirals like cidofovir and interferon can be prescribed. Laser therapy should be avoided to prevent the distal spread.

Reinke’s Edema

• This space between the epithelium and the superficial lamina propria of the larynx is called Reinke’s edema.
• Sometimes there is an accumulation of the edematous tissue or the myxomatous tissue in this space and the most common cause for this is smoking. The other causes are chewing tobacco, excessive voice abuse, reflux, and sometimes due to hormonal abnormalities.
• The patient will present with Diplophonia or a change in voice.
• On examination there will be a bag with a water-like appearance due to bilateral symmetrical swellings of the vocal cord.
• The treatment is done by stripping of the vocal cord.

Hope you found this blog helpful for your ENT residency Larynx preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.