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

 Causative

of voice?

factors leading to hoarseness

Acute or chronic infections

Benign mucosal fold disorders
Systemic disease
Gastroesophageal reflux
Malignancies, etc

BENIGN MUCOSAL
FOLD DISORDERS ARE
COMMON

>50% PATIENTS WITH

VOICE COMPLAINTS
HAVE A BENIGN
MUCOSAL DISORDER
Benign mucosal fold
lesion like vocal
nodules, polyps,
intracordal cysts,
contact ulcers, etc

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

Vocal Polyps

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.

Laryngopharyngeal reflux (LPR)

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.

Reinkes edema

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

Intracordal (vocal cord)

cysts

Was seen in 4% patients

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

Contact ulcers

Was seen in 3% patients

Made up of thickened
epithelium with a central
indetation
Can be bilateral and
symmetrical

Laryngeal
papillomatosis

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

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

23.07

37

37

Vocal polyps

18

29.50

20.51

26

26

LPR

13.11

15

38.46

23

23

Reinkes
odema

4.91

2.56

Intracordal
cysts

3.27

5.12

Contact ulcer

1.63

5.12

Saccular cyst

1.63

2.56

Papillomatosis

2.56

Lesion

Table 7: Shows various cord lesions observed (in our study) with percentage of
male/female cases in each lesion.

THANK YOU