| Acute viral laryngitis | Viral URTI preceding aphonia +/− of sore throat. | Bilateral vocal cord edema and erythema. | Improves usually with resolution of URTI Conservative treatment with voice rest. | Antibiotic if 2° bacterial infection. Most common infectious cause of hoarseness. |
| Vocal cord nodules | Occurs more frequently in singers, females and children. Aggravated by URTI, sinusitis, smoke and alcohol. | Often arise bilaterally at the junction of the anterior and middle 1/3 of the vocal cords. Soft and red, but chronic nodules become fibrotic, hard and white. | Voice rest. Speech therapy. Rarely is surgery ever indicated. | Caused by sub mucosal inflammation. |
| Laryngitis 2° to GERD | Hx of GERD and its precipitating factors. | Erythema and edema of the mucosa lining the arytenoids, may develop ulcers or granulomas in a similar distribution. | Treatment as for reflux conservative vs. medications vs. surgery. | |
| Vocal cord polyp | Males, smokers, vocal misuse or abuse or irritant exposure +/- dyspnea, cough. | Unilateral, asymmetric, broad based and pedunculated with a smooth, soft appearance (can occur bilaterally). | Voice rest. Speech therapy. Surgical excision. | The diffuse form is called Reinke’s edema, which is due to fluid accumulation in the loose submucosal space. |
| Squamous papillomas | Often occur at the anterior commisure and true vocal cord subglottic and supraglottic areas may be involved. Appears as white to reddish verrucous mass. | complete surgical excision/laser extirpation. | Most common benign tumor. | |
| Glottic carcinoma | Predisposing factors: alcohol, smoking, exposure to radiation, HPV and nickel exposure Symptoms include dysphagia, odynophagia, otalgia and hemoptysis. | Lesions will vary in appearance dysplasia or CIS may appear as leukoplacia, Often exophytic, ulcerated growth on vocal cord membrane. | Due to poor lymphatic supply tumor spread at time presentation is not common. | Refer to otolaryngologist. Biopsy. Organ preservation therapy: Radiation therapy or surgery. |
| Psychogenic | Patient will complain of only being able to speak in forced whisper. | Normal cough Ability of patient to say ‘Ah’ in their normal voice. | A conversion disorder. | |
| Spastic dysphonia | Strained, strangled voice associated with facial grimacing, during singing, crying or laughing the voice is normal. In some onset is related to major life stressor. | Hyper adduction of the true and false cords. | Botulinum toxin injection. Speech therapy (work if it is psychogenic in nature as opposed to neurological). | |
| Cord paralysis | Breathy voice due to air escape – Bilateral paralysis may lead to airway compromise. Hx of recurrent laryngeal nerve damage (thyroid or CV surgery or disease). | Unilateral: Cord abducted in resting position and unable to adduct during phonation. Bilateral: cords adducted, unable to abduct with little space between. |
Unilateral: Manage expectantly, or thyroplasty surgery where the paralyzed cord is medialized. Bilateral – Often needs a temporary trach. | |
| Trauma | Hx of trauma to the larynx. Traumatic induced lesions of the vocal cord 2° to voice abuse (screaming, excessive singing without proper training). | Severe trauma can result in fracture, dislocation etc. trauma due to vocal abuse results in benign vocal cord polyps, nodules or contact granulomas. | Treatment depends upon the type of injury and treatment as above for polyps and nodules external trauma may require airway control, and surgery. | With external trauma assess larynx mucosa, cartilage and joints. |