Benign laryngeal lesions

Last updated: June 24, 2022

Summarytoggle arrow icon

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.

Vocal fold polyptoggle arrow icon

Vocal fold noduletoggle arrow icon

Vocal fold cysttoggle arrow icon

  • 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
  • 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

Vocal fold granulomatoggle arrow icon

Reinke edematoggle arrow icon

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.

Laryngeal papillomatosistoggle arrow icon

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

Precancerous lesions of the larynxtoggle arrow icon

Differential diagnosestoggle arrow icon

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
  • Unilateral
  • Spherical lesion
Vocal fold cyst
  • Peak incidence: primarily children (2–4 years)
  • Obstruction of mucus-secreting glands caused by congenital anomaly
  • 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
  • Bilateral
Vocal fold nodules
  • 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.

Referencestoggle arrow icon

  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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 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer