Benign laryngeal disease

Overview

Laryngeal problems can occur as a consequence of straining or damaging the vocal cords, or as a result of a viral infection. The diagnosis of laryngeal and vocal cord problems begins with a doctor's examination, which involves a scope or mirror exam to check the larynx and throat.

Larynx anatomy

The larynx is situated in the anterior region of the neck, prior to the inferior pharynx and superior to the trachea. Its principal role is to defend the lower airway by quickly shutting upon mechanical stimulation, interrupting breathing and preventing foreign materials from entering the airway. Other functions of the larynx include sound generation (phonation), coughing, the Valsalva maneuver, ventilation management, and functioning as a sensory organ.

The larynx is composed of

Three large, unpaired cartilages (cricoid, thyroid, epiglottis);
Three pairs of smaller cartilages (arytenoids, corniculate, cuneiform); and
A number of intrinsic muscles.

While technically not a component of the larynx, the hyoid bone offers muscle attachments from above that help in laryngeal mobility.

Acute Laryngitis

One of the most frequent laryngeal disorders is laryngitis, which is an inflammation of the larynx. It appears in both acute and chronic forms.

Acute laryngitis generally has a sudden start and is self-limiting. Chronic laryngitis occurs when a patient exhibits symptoms of laryngitis for longer than three weeks. Acute laryngitis is caused by a variety of factors, including vocal overuse, exposure to noxious or pathogenic chemicals, and upper respiratory tract diseases. The infectious agents are usually viral, although they can also be bacterial.

An autoimmune illness, such as rheumatoid arthritis, relapsing polychondritis, Wegener granulomatosis, or sarcoidosis, may cause laryngeal inflammation in rare cases.

Chronic laryngitis, as the name indicates, has symptoms that last for a longer period of time and takes longer to develop. Environmental causes such as cigarette smoke or polluted air inhalation, asthma inhaler irritation, vocal abuse (ie, extended vocal usage at aberrant loudness or pitch), or gastrointestinal esophageal reflux can all cause chronic laryngitis. Vocal abuse increases the adducting force of the vocal folds, resulting in greater contact and friction between the contacting folds. The region of contact between the folds swells. Vocal therapy is most beneficial in patients with persistent laryngitis.

Although vocal abuse is not generally the cause of acute laryngitis, it is frequently the cause of acute laryngitis. A hoarse voice is caused by an underlying illness or inflammation. In most cases, the patient aggravates the dysphonia by misusing his or her voice in an attempt to retain premorbid phonating abilities.

Signs and symptoms of acute laryngitis

The patient has dysphonia or a hoarse voice in addition to the symptoms of an upper respiratory tract infection (fever, cough, rhinitis). The following symptoms may also be experienced by the individual:

Odynophonia
Dysphagia
Odynophagia
Dyspnea
Rhinorrhea
Postnasal discharge
Sore throat
Congestion
Fatigue
Malaise

Workup in acute laryngitis

In the case of acute laryngitis, no laboratory tests are required. A culture may be done if the patient has an exudate in the oropharynx or overlaying the vocal folds. To obtain a view of the larynx, direct fiberoptic or indirect laryngoscopy may be used. On the irritated vocal folds, this examination displays redness and little dilated capillaries.

The movement of the vocal folds demonstrates asymmetry and aperiodicity, as well as diminished mucosal waves and partial vibratory closure. The mucosal wave's propagation is likewise slowed.

Management of acute laryngitis

The following measures can help to lessen the intensity of laryngitis as the patient waits for the condition to resolve:

Inhaling humidified air encourages moisture in the upper airway, which aids in the clearance of secretions and exudate.
Although complete voice rest is recommended, it is nearly hard to follow; if the patient must talk, quiet sighing phonation is ideal. Whispering should be avoided since it causes laryngeal hyperfunction.
The available evidence does not support the usage of antihistamines plus corticosteroids.

Dietary and lifestyle changes, as well as antireflux drugs, are used to treat laryngitic symptoms caused by gastroesophageal reflux disease (GERD). H2-receptor and proton pump blocking medicines, as well as antacid drugs that decrease acid production, are extremely effective against gastroesophageal reflux. Proton pump inhibitors are the most effective of the numerous kinds of medications available to treat GERD.

Benign Laryngeal Tumors

Juvenile papillomas, hemangiomas, fibromas, chondromas, myxomas, and neurofibromas are examples of benign laryngeal tumors. They can occur anywhere in the larynx. Papillomas and neurofibromas can develop into cancer.

Hoarseness, a breathy voice, dyspnea, aspiration, dysphagia, otalgia (ear discomfort), and hemoptysis are all symptoms of benign laryngeal tumors. Otalgia is referred pain to the ear produced by irritation or distension of the vagus nerve, and is most commonly caused by a rapid developing malignant tumor.

The diagnosis of benign laryngeal tumors is based on direct or indirect inspection of the larynx, which is complemented by computed tomography (CT).

The voice, the functional integrity of the laryngeal sphincter, and the airway are all restored after removal. Smaller lesions can be removed endoscopically under general anesthesia using a CO2 laser. Larger lesions that extend outside the laryngeal framework may necessitate pharyngotomy or laryngofissure.

Vocal Cord abnormalities

here are several disorders of the larynx that can be caused by strain or injury to the vocal cords through things like:

Excessive talking
Throat clearing
Coughing
Smoking
Screaming
Singing
Speaking too loudly or even too quietly.

Voice abuse and overuse can eventually lead to alterations in vocal function and hoarseness. If your hoarseness persists for more than two to four weeks without explanation, you should consult an ear, nose, and throat specialist. Abuse, misuse, or overuse of your voice can result in the following disorders:

Laryngitis: This condition is an inflammation (swelling) of the vocal cords.
Vocal cord nodules: Small, benign, callus-like, inflammatory lesions (growths) arise on your focal cords as a result of this disorder. Nodules are one of the most prevalent types of non-cancerous vocal lesions. Professional singers and persons with high vocal demands (such as teachers, attorneys, or salespeople) are more likely to acquire vocal cord nodules.

Vocal cord polyps: These vocal cord lesions are usually the result of an accident (post-traumatic) or an inflammatory process. They are caused by a vocal cord damage caused by excessive vocal cord demand or prolonged coughing. People who smoke are also more likely to have polyp-like abnormalities in their voice cords.
·Vocal cord hemorrhage: You may notice a sudden loss of voice in this scenario. This can occur as a result of screams, shouts, or other demanding vocal duties. A hemorrhage occurs when one or more of the blood vessels on the surface of the vocal cord burst and flood the soft tissues with blood. Resting your voice until the bleeding disappears is the treatment.
Professional voice disorders: While the title suggests that a person must be a professional speaker or singer, anybody who utilizes their voice for employment is a professional voice user. Teachers, counselors, customer service workers, and sales people are among the professions most at danger.
Spasmodic dysphonia: This is a rare laryngeal neurologic disorder characterized by involuntary muscular contraction (tightening) of certain muscles within the voice cords or larynx. As a result, your voice will sound strained, strangled, or intermittently breathy.
Vocal cord paralysis or vocal cord hypomobility: When one or both of the voice cords in the larynx do not open or close properly, this disease occurs. When air trapped in your lungs is released and flows through the vocal cords, it causes them to vibrate and generate sounds, allowing you to communicate. In addition to impairing speech, vocal cord paralysis can produce coughing, a phlegmy sensation in the throat, trouble swallowing, and shortness of breath when speaking. Although a breathy and weak voice is the most common symptom, symptoms of vocal cord paralysis can be more severe.
Vocal cord motion disorders: Thyroid surgery, vascular surgery, thoracic surgery, spine surgery, lengthy or traumatic installation of a breathing tube, or a viral infection can all cause these problems.
Laryngopharyngeal reflux (LPR): This ailment is also known as acid reflux disease, heartburn, or gastroesophageal reflux disease (GERD). Gastroesophageal reflux is characterized by a burning sensation in the chest that might develop as a result of eating, bending, stretching, exercising, or lying down. GERD occurs when stomach contents go back up into the esophagus. When the lower esophageal sphincter (LES) valve, which controls the flow of food from the esophagus to the stomach, fails to seal properly, this can occur. The symptoms of this illness are more typical of heartburn. Reflux can damage the larynx, resulting in unusual symptoms such as coughing, hoarseness, inflammation, and sore throat. In these circumstances, the condition is known as laryngopharyngeal reflux (LPR). LPR may be accompanied with frequent coughing, throat clearing, excess mucus and phlegm, and a lump in the throat.
Laryngeal stenosis: This disorder is characterized by a constriction of the vocal cord airway caused by scarring or two-sided (bilateral) vocal cord immobility (inability to move), which can cause breathing difficulties. It can be caused by a variety of conditions, including autoimmune or inflammatory disorders like polyangiitis with granulomatosis, traumatic injuries from prolonged intubation, iatrogenic conditions (those caused by medical treatment, like thyroid surgery), malignant (cancerous) conditions, progressive neurologic degenerative conditions, or rare viral infections.

Laryngeal Papillomatosis

A frequent benign laryngeal tumor is laryngeal papillomatosis. Human papillomavirus (HPV), primarily subtypes six and eleven, causes papillomas. These are most common in youngsters, but they can occur at any age. They can develop quite fast in maturity and reoccur frequently. Their removal necessitates surgery.

Causes or Contributing Factors

More than 60 different strains of human papillomavirus (HPV) have been linked to laryngeal papillomatosis. It is yet unknown how humans become infected with the virus.

Risks factors for cancer of the larynx include:

Smoking
Heavy alcohol consumption: especially when combined with smoking
Age :laryngeal cancer is more common in people over 55
Gender :men are four times more likely than women to contract the disease
Race :African-Americans have a higher incidence of laryngeal cancer
Exposure to materials such as asbestos or other cancer-causing environmental substances

Laryngeal Papillomatosis Diagnosis

Our staff will go over your symptoms and medical history with you. We will do a complete head and neck exam. Several Emory Voice Center personnel are frequently included on our evaluation team. We'll look at things like vocal quality, efficiency, and good speaking technique.

A laryngeal videostroboscopy may be performed. An endoscope is used in this minimally invasive technique (a small tube equipped with a fiber optic camera.) We may examine laryngeal function and vibration using a stroboscopic light source.

A direct laryngoscopy or a microlaryngoscopy may be performed. A physician will use magnification instruments to examine the vocal folds of the larynx. This surgery is performed under general anesthesia. The doctor may collect tissue samples for a biopsy or remove a growth or tumor.

Treatments for Laryngeal Papillomatosis

Laser ablation of the lesions can be used to eradicate laryngeal papillomas. This is a minimally invasive procedure that may be performed on an awake patient to treat mild to moderate papilloma. Patients handle it well, are able to drive themselves to and from their treatments, and may frequently return to work on the same day as treatment.

In the operating room, both the laser and a carbon dioxide laser can be utilized on a patient who is under general anesthesia. These, and other procedures, are used to assist prevent harm to typical healthy vocal fold tissue.
We also provide Gardasil vaccine to assist address the probable viral source of the papilloma. According to preliminary study, this reduces the course of papilloma growth. Severe forms of laryngeal papillomatosis may necessitate further medical care, such as chemotherapy.

Reinke's Edema

Reinke's edema can alternatively be referred to as polypoid degeneration or chronic edematous hypertrophy. It is noticed in individuals in their forties and fifties, and up to 98 percent of them are smokers. Heavy smoking, working in a smoking workplace, and a history of voice abuse are all risk factors. It is more common in females; however, this may be due to the fact that it lowers the pitch of their voices and is more evident in a female voice. It is almost often bilateral and persistent. The therapy consists of quitting smoking, reducing voice abuse, and reducing other environmental exposures. If the edema worsens, surgery may be necessary.

How are diseases of the larynx diagnosed?

Laryngeal diseases are generally diagnosed by a professional, such as a laryngologist or an otolaryngologist. Your physician will begin by performing a physical evaluation of your throat and larynx. This may include the use of a scope (a short, flexible tube-like equipment with a camera on the end) or a mirror to view into your throat.

Depending on your symptoms, your provider might also want to do additional tests. These tests might include:

Imaging studies.
Biopsies.
Endoscopic (using a scope) examinations.

A scope exam will be done to begin the diagnosis if your clinician suspects you have vocal cord paralysis. In some cases, your doctor may additionally request a laryngeal electromyography (LEMG). The nerve input to the laryngeal muscles is measured with this test. It can aid in the diagnosis and prediction of whether or not you will regain vocal fold function.

Management

Your therapy choices for laryngeal issues might vary depending on your diagnosis. If your illness is the result of vocal abuse, misuse, or overuse, therapy may be as simple as resting your voice for a short amount of time. To help you fully heal, your practitioner may also recommend voice or singing therapy. A speech-language pathologist is usually in charge of this therapy.

In some circumstances, more than just rest may be required to treat your disease. If you have laryngeal cancer, for example, your treatment choices may include:

Surgery.
Radiation therapy.
Chemotherapy.

Your treatment plan might involve a combination of these therapies.

Treatment for laryngeal and vocal cord disorders might vary greatly. The finest solution for you may not be the best option for the next individual. Several aspects will be evaluated by your provider when choosing the optimal treatment strategy for you, including:

Your medical condition.
Your age.
Your profession.

All of these aspects will be considered by your healthcare professional when developing your personalized treatment plan. Discuss your treatment objectives and concerns with your provider. Having an open dialogue with your clinician will aid in the treatment of your problem.

What can be done to prevent diseases of the larynx?

There are several things that you can do to prevent diseases and other conditions of the larynx. These include:

Eliminating harmful lifestyle habits: Quitting smoking and limiting your alcohol use can help avoid laryngeal cancer.
Not straining your voice: Taking precautions to avoid overusing or misusing your voice can also help to prevent diseases such as polyps and nodules. This is especially vital if you spend a significant amount of time speaking. Singers, professors, and attorneys are among occupations where regular speaking or singing can strain your voice. It is critical to relax your voice, maintain a healthy lifestyle that includes physical activity, and control any annoying circumstances that might impair your voice. Allergies and reflux are examples of such variables.

Most laryngeal disorders are curable if you contact your healthcare professional as soon as you detect symptoms. If you see anything out of the ordinary, call your provider right away since some disorders can cause irreversible harm to your larynx and voice.

Conclusion

Vocal fold polyps, vocal fold nodules, vocal fold cysts, vocal fold granulomas, Reinke edema, and laryngeal papillomatosis are all examples of benign laryngeal lesions. The majority of these lesions form as a result of chronic vocal cord irritation (e.g., smoking, voice overuse, GERD), whereas laryngeal papillomatosis is caused by HPV.

Hoarseness is the most common symptom of these disorders. Laryngoscopy, with or without biopsy, is frequently used to make a diagnosis. Management is determined by clinical findings and may include both conservative (e.g., smoking cessation, vocal rest) and surgical techniques. Precancerous lesions of the larynx include laryngeal papillomatosis, leukoplakia, and pachyderma.