Benign laryngeal lesions

Last updated: June 24, 2022

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Common benign lesions of the larynx include vocal fold polyps, vocal fold nodules, vocal fold cysts, vocal fold granulomas, Reinke edema, and laryngeal papillomatosis. Most of these lesions develop as a consequence of chronic irritation of the vocal cords (e.g., smoking, voice overuse, GERD), while laryngeal papillomatosis is caused by HPV. The cardinal symptom of these conditions is hoarseness. Laryngoscopy with or without biopsy is usually indicated for diagnosis. Management depends on the clinical findings and includes conservative management of underlying causes (e.g., smoking cessation, vocal rest) and surgical approaches. Laryngeal papillomatosis, leukoplakia, and pachyderma are all lesions of the larynx that are considered precancerous.

  • Definition: benign, sac-like structure in the lamina propria of the vocal cords due to obstruction of mucus-secreting glands
  • Epidemiology: Occurs in all ages; often in children
  • Etiology: obstruction of laryngeal mucus-secreting glands
    • Retention cysts: obstruction caused by inflammation due to high vocal stress (e.g., occupational)
    • Epidermoid cysts: obstruction caused by congenital anomaly or secondary to a vocal trauma
      • In children: typically a congenital anomaly
  • Classification:
  • Clinical features
    • Intracordal cyst: hoarseness
    • Saccular cyst: airway obstruction, voice change
  • Diagnostics: laryngoscopy typically shows unilateral yellow-white lesion with distinct border
    • Saccular cyst: supraglottic mass
    • Intracordal cyst: middle third of the vocal cord associated with an area of hyperkeratosis on the opposite cord
  • Treatment: microsurgical removal

Significant smoking history is also a risk factor for vocal fold leukoplakia and laryngeal cancer, so it is important to clearly visualize the vocal cords during diagnosis of Reinke edema and evaluate for other lesions in the area as well.

  • Definition: benign tumor of the laryngeal epithelium caused by human papillomavirus (HPV) infection of the throat
  • Classification
    • Juvenile onset recurrent respiratory papillomatosis (JORRP): < 20 years of age
      • Peak onset < 5 years of age
    • Adult onset recurrent respiratory papillomatosis (AORRP)
  • Etiology: HPV infection (especially HPV6 and HPV11; followed by HPV subtypes 16, 18, 31, and 33) [4]
  • Clinical features: disease extent is highly variable
  • Diagnostics: laryngoscopy
    • Multiple raspberry-like swellings
    • Usually located on vocal cords
    • Can be unilateral or bilateral
  • Management: no definitive cure, goal is to limit disease spread
  • Complications
  • Prognosis
    • Frequently recurring
    • Often regresses spontaneously in puberty

Papillomas that remain till adulthood are potential precancerous lesions. Although it rarely occurs, papillomas can undergo malignant transformation and become squamous cell carcinoma.

Differential diagnoses of benign laryngeal lesions
Epidemiology Etiology Clinical features Laryngoscopy
Localization Morphology
Vocal fold polyp
  • Voice overuse (e.g., teachers, professional singers)
  • Smoking, GERD
  • Hoarseness
  • Low-pitched, whispery voice
  • Unilateral
  • Spherical lesion
Vocal fold cyst
  • Peak incidence: primarily children (2–4 years)
  • Obstruction of mucus-secreting glands caused by congenital anomaly
  • Hoarseness, voice change
  • Airway obstruction
  • Saccular cyst: supraglottic mass
  • Intracordal cyst: middle third of the vocal cord associated with an area of hyperkeratosis on the opposite cord
  • Yellow-white lesion with distinct border
Reinke edema
  • Smoking
  • Hoarseness
  • Low-pitched, rough voice
  • Bilateral
Vocal fold nodules
  • Peak incidence 15–45 years
  • Sex: >
  • Most common cause of persistent hoarseness in children
  • Voice overuse (e.g., teachers, professional singers) or abuse (screaming children)
  • Hoarseness that increases with overuse of the voice
  • Low-pitched, whispery voice
  • Symmetric, pinhead-sized, pale nodules
  • Variable color, contour, and/or shape
Vocal fold granulomas
  • Mushroom-shaped
  • Whitish shimmering fibrin coating
Laryngeal papillomatosis
  • Juvenile onset: peak onset < 5 years of age
  • Adult onset: peaks at 20–40 years
  • Unilateral or bilateral
  • Papillomas: usually multiple raspberry-like swellings

The differential diagnoses listed here are not exhaustive.

  1. Jain S, Varma R, Hazarika B, Pradhan S, Momin A. Reinke′s edema. Indian Journal of Radiology and Imaging. 2009; 19 (4): p.296. doi: 10.4103/0971-3026.57212 . | Open in Read by QxMD
  2. Reinkes Edema - Treatment. . Accessed: April 7, 2021.
  3. Ribeiro El-Achkar VN, Duarte A, Pinto Saggioro F, et al. Squamous Cell Carcinoma Originating from Adult Laryngeal Papillomatosis: Case Report and Review of the Literature. Case Reports in Otolaryngology. 2018; 2018 : p.1-5. doi: 10.1155/2018/4362162 . | Open in Read by QxMD
  4. Kostev K, Jacob L, Kalder M, Sesterhenn A, Seidel D. Association of laryngeal cancer with vocal cord leukoplakia and associated risk factors in 1,184 patients diagnosed in otorhinolaryngology practices in Germany. Molecular and Clinical Oncology. 2018 . doi: 10.3892/mco.2018.1592 . | Open in Read by QxMD
  5. Vocal Cord Disorders. . Accessed: April 7, 2021.
  6. Recurrent Respiratory Papillomatosis. . Accessed: April 29, 2021.
  7. Overview of Head and Neck Tumors.,-nose,-and-throat-disorders/tumors-of-the-head-and-neck/overview-of-head-and-neck-tumors. Updated: April 1, 2018. Accessed: January 13, 2019.

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