Otorhinolaryngology (ENT)
Diseases of the Larynx
Larynx disease for MBBS ENT: laryngitis, vocal nodules and polyps, vocal cord paralysis, laryngeal carcinoma and paediatric stridor, mapped to NMC codes EN3 and EN4.
MedNext Academy | 3 min read
Diseases of the Larynx
Larynx disease for MBBS ENT: laryngitis, vocal nodules and polyps, vocal cord paralysis, laryngeal carcinoma and paediatric stridor, mapped to NMC codes EN3 and EN4.
This chapter covers disorders of the larynx and voice. It includes acute and chronic laryngitis, benign vocal cord lesions, vocal cord paralysis and its causes, laryngeal carcinoma and paediatric airway problems such as laryngomalacia, with a strong emphasis on the red flag of persistent hoarseness.
High-yield: Diseases of the Larynx
- Hoarseness lasting more than three weeks, especially in a smoker, must be investigated to exclude laryngeal carcinoma.
- Acute laryngitis is usually viral and self-limiting, and voice rest is a key part of management.
- Vocal nodules (singer nodules) are bilateral swellings at the junction of the anterior and middle thirds of the cords from voice overuse.
- A vocal polyp is usually unilateral and follows a single episode of vocal strain or trauma.
- The recurrent laryngeal nerve supplies all intrinsic laryngeal muscles except the cricothyroid, so its palsy causes vocal cord paralysis.
- The left recurrent laryngeal nerve has a longer intrathoracic course and is more often injured, for example by lung or mediastinal disease.
- Bilateral abductor (posterior cricoarytenoid) paralysis leaves the cords near the midline and threatens the airway with stridor.
- A cord in the paramedian position after unilateral palsy often allows a reasonable voice because the other cord compensates.
- Laryngeal carcinoma is strongly linked to smoking and alcohol, and glottic tumours present early with hoarseness.
- Glottic cancer has a better prognosis than supraglottic cancer because the glottis has poor lymphatic drainage, so it spreads and nodes late.
- Laryngoscopy, direct or indirect, is essential to assess the cords, and biopsy confirms a suspected tumour.
- Laryngomalacia is the commonest cause of stridor in infants and usually resolves as the larynx matures.
- Reinke oedema is diffuse swelling of the vocal cords associated with chronic smoking, giving a low, gruff voice.
- Any persistent change in voice deserves visualisation of the vocal cords rather than reassurance alone.
Benign vocal cord lesions and paralysis
- **Vocal nodules:** Bilateral, at anterior-middle third junction, from voice overuse. Singers, teachers.
- **Vocal polyp:** Usually unilateral, after a single episode of vocal strain or trauma.
- **Reinke oedema:** Diffuse cord swelling in chronic smokers, gives a low gruff voice.
- **Recurrent laryngeal palsy:** Cord paralysis. Left nerve more often affected due to its longer thoracic course.
NMC competencies in this chapter
- **EN3.3:** Aetiology, features and management of diseases of the larynx
- **EN4.42:** Acute and chronic laryngitis
- **EN4.43:** Benign lesions of the vocal cords
- **EN4.44:** Vocal cord paralysis: causes and management
- **EN4.45:** Carcinoma of the larynx: features and management
- **EN4.46:** Paediatric laryngeal disorders and stridor
Frequently Asked Questions
Why is persistent hoarseness a red flag?
Hoarseness lasting more than three weeks, particularly in a smoker, may be the first sign of laryngeal carcinoma, so the vocal cords must be examined rather than the voice simply rested.
What is the difference between vocal nodules and a vocal polyp?
Nodules are bilateral swellings at the anterior-middle third junction from chronic voice overuse. A polyp is usually a single unilateral lesion following one episode of vocal strain or trauma.
Why is the left recurrent laryngeal nerve more often injured?
It loops under the aortic arch and has a longer course in the chest, so it is more exposed to lung, mediastinal and thyroid disease that can cause left vocal cord paralysis.
Why does glottic cancer have a good prognosis?
The glottis has sparse lymphatic drainage, so glottic tumours present early with hoarseness and spread to lymph nodes late, giving them a better outlook than supraglottic cancers.
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