Benign Mucosal Fold Lesion as a

Cause of Hoarseness of Voice A

Clinical Study
Tutors:
Dr. Tris Sudyartono, Sp.THT-KL
Dr. Agus Sudarwi, Sp.THT-KL
Dr. Santo Pranowo, Sp.THT-KL

Presented by:
Christian Salim (11-2013-296)
Kristali (11-2013-321)
Fransiskus Rendy (11-2013-277)
Gandy (11-2013-066)

ABSTRACT

Hoarseness of voice is a
common disorder seen in
day to day practice
Vocal nodules were the
commonest benign mucosal
fold lesion (37% patients)

INTRODUCTION

Hoarseness is a vague term that patients
often use to describe a change in voice
quality, ranging from voice hoarseness to
voice weakness
It refers to laryngeal dysfunction by abnormal
vocal cord vibration


1

Causative factors leading to hoarseness
of voice?
Acute or chronic infections
Benign mucosal fold disorders
Systemic disease
Gastroesophageal reflux
Malignancies, etc



BENIGN MUCOSAL
FOLD DISORDERS ARE
COMMON
Benign mucosal fold
lesion like vocal
nodules, polyps,
intracordal cysts,
contact ulcers, etc
>50% PATIENTS WITH
VOICE COMPLAINTS
HAVE A BENIGN
MUCOSAL DISORDER

Benign mucosal fold lesions like vocal nodules,
polyps, intracordal cyst, contact ulcer, etc seem to
be caused primarily by vibratory trauma ( excessive
voice uses)

Cigarette smoking, infections, allergy and acid reflux
increase the mucosas vulnerability to vibratory
trauma leading to injury
MATERIAL & METHODS

Where?
The present prospective study was
conducted in the ENT Department of
SKIMS Medical College, Bermina, Srinagar

Subject?
Patients with history of hoarseness of voice
as a predominant symptom or associated
a symptoms of other complaints like
cough, pain, foreign body sensation,
dryness of throat, etc.
Patients with hoarseness of voice at least
six months
Patients with acute infections, carcinomas,
vocal cord palsy or other neurological
diseases were excluded

Methods?
Detailed history of
general physical
examination, routine
investigations, and
indirect laryngoscopy

Fiber optic laryngoscopy
was done in patient with
difficult indirect
laryngoscopy because of
other reasons.




OBSERVATION
The vocal nodules were the commonest
lesion seen. Present in 37% patients
Vocal polyps 26%
Laryngopharyngeal reflux 23%
Reinkes edema 4%
Intracordal cysts 4%
Contact ulcer 3%
Saccular cysts 2%
Papilomatosis1%

Age-group (commonly affected) 30-40 years
Table 2: Showing the most common age-group among selected cases.
Positive history Number of cases
History of vocal abuse 45%
History of smoking 47%
History of alcoholism 7%
Table 3: Showing Cases with Past History.
Predominant symptom Percentage of cases
Hoarseness 73%
Cough 20%
Foreign body sensation 19%
Heart burn 17%
Throat clearing 13%
Low grade pain 9%

Site of lesion Percentage (%) (of cases)
Anterior 1/3 of vocal cord 47%
Middle 1/3 of vocal cord 11%
Posterior 1/3 of vocal cord 22%
Diffuse 20%
Table 6: Showing percentage of cases with respect to site of lesion of
vocal cord
DISCUSSION
Vocal Nodule
Bilateral symmetrical
epithelial nodular swelling
of interior middle third of
true vocal folds

Pedunculated masses
encountered on true vocal
cords.
Vocal polyps were seen in
26% & in all cases were
unilateral
Common in males, often
intense intermittent voice
abuse, history of aspirin or
anticoagulant use or other
vocal trauma such as
endotracheal intubation.


Vocal Polyps
In the present study, 23% patients were diagnosed as having features of
laryngopharyngeal reflux (LPR) and the same was labeled as the cause for
hoarseness of voice

Besides this positive history, the patients on examination were having some or all the
findings like vocal cord odema, subglotic odema, ventricular obliteration
esthema/Hyperemia, diffuse laryngeal odema, posterior commisure hypertrophy and
granuloma/s lesions etc.


Laryngopharyngeal reflux (LPR)


Was seen in 4% patients
Definition: proliferation or redundancy of
superficial lamina propria
Often seen in patients who have chronic
irritant exposure such as tobacco smoke, LPR,
and sometimes occupational exposure


Reinkes edema





Was seen in 4% patients
Definition: sub epidermal
epithelial lined sacs
located within laminar
propria and may be
mucus retention or
epidermoid in origin


Intracordal (vocal cord)
cysts

Was seen in 3% patients
Made up of thickened
epithelium with a central
indetation
Can be bilateral and
symmetrical


Contact ulcers

1% patient
Caused by HPV
One of the commonest
laryngeal neoplasms



Laryngeal
papillomatosis

Lesion
Males (Total No. 61) Female (Total No.
61)
Total No. 100
No of Patients % No of Patients % No of Patients %
Vocal nodules 28 45.90 9 23.07 37 37
Vocal polyps 18 29.50 8 20.51 26 26
LPR 8 13.11 15 38.46 23 23
Reinkes
odema
3 4.91 1 2.56 4 4
Intracordal
cysts
2 3.27 2 5.12 4 4
Contact ulcer 1 1.63 2 5.12 3 3
Saccular cyst 1 1.63 1 2.56 2 2
Papillomatosis - - 1 2.56 1 1
Table 7: Shows various cord lesions observed (in our study) with percentage of
male/female cases in each lesion.


THANK YOU