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Craig R. Villari Melissa M. Statham
Multiple infectious and benign conditions can affect
laryngeal biomechanics and detrimentally affect laryngeal function and vocal performance. A variety of clini
cal presentations is possible ranging from dysphonia or
dysphagia to airway compromise depending on pathol
ogy, the affected laryngeal subsite(s), and premorbid
laryngeal anatomy. Treatment is targeted to the specific
pathology, which is usually diagnosed from a thorough
history, physical examination, and detailed laryngoscopy,
but may also require more specific laboratory or radio
logic examination .
INFECTIONS OF THE LARYNX
Viral Laryngitis
The most common cause of infectious laryngitis isviral
(). !iral laryngitis is typically self "limited with a normal
dura tion of # to $ days (%). &atients are usually
dysphonic but may also present with odynophagia.
'istory may include a viral prodrome with upper
respiratory tract symptoms and physical examination
usually demonstrates edema tous, erythematous vocal
folds (ig. $.) with loss of normal vibratory
pliability.Treatment includes supportive care with
hydration and removal of laryngeal phonotory trauma
(phonation and coughing, pollutants). The most common
viral pathogens in the upper respiratory tract include
rhinovirus, influen*a A, +, , and parainfluen*a viruses.
&atients with substantive vocal fold edema from viral
laryngitis are at increased ris- of repetitive phono trauma
leading to more significant vocal fold inury, such as
midmembranous vocal fold lesions, epithelial and sub
epithelial trauma/ulceration, and scar (0). As such , these
patients should ideally be limited to relative or absolute
voice rest. 1vidence suggests that anti"inflammatory
medi cation may decrease subective discomfort and
decrease odynophagia, but one would not expect such
treatment to decrease duration of illness as it could notaffect the
978
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erlying viral etiology (2). 3ystemic corticosteroids may be
*ed udiciously to treat moderate to severe laryngeal edema
ciated with very substantial symptoms, espe cially in patients
h significant vocal demands that can not be mitigated with
avioral modification. Antibiotics are not indicated in patients
enting with symptoms typical of viral laryngitis (). Acute
phonia lasting lon ger than % wee-s is unli-ely to result from
l laryngitis, and other etiologies should be investigated,
uding a detailed laryngoscopy.
cterial Laryngitis
ough rare, the physician should begin to consider a
erial etiology when the supportive measures dis cussed above
to decrease symptoms or if symptoms worsen after an initial
eau of symptoms. 4nitial clini cal presentation may be similar to
of viral laryngitis, but supraglottitis and epiglottitis may result.
with the pediatric population, these conditions require escalated
care, given the potential for airway demise. The causative
bacteria are also similar to those in the pediatric popu
lation and include Haemophilus influen z ae , Streptococcus
species, and Staphyloco ccus species. Haemophilus spe cies
remain the most common but methicillin"resistant
Staphylococcus aureus infections have been reported (,#"
$).
5iagnosis relies on endoscopic examination (ig.
$.%) of the larynx. 6adiologic imaging may be used to
supple ment endoscopic evaluation, and findings can
include the classic 7thumb"print7 sign of supraglottic
inflamma tion. Tr eatment depends on the clinical
presentation with attention focused on airway
competence. 4n a recent study, only % of 8 adult patients
with supraglottitis evaluated over a "month period
requir ed airway intervention (9). 5espite the maority of
patients not needing airway pro tection, incr eased wor-
of breathing and/or stridor must
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3 Section IV: Laryngology Chater !": In#ection$ In#iltration$ an% Benign Neolas&s o# the Laryn' ("(
Fig)re !"*+ Acute laryngitis: note global laryngeal edema anderythema.
be given proper credence. Medical treatment is targeted
to the pathogen identified by culture. Additionalsupportive measures such as hydration and steroids are
indicated (;). Though not common in the
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4 Section IV: Laryngology Chater !": In#ection$ In#iltration$ an% Benign Neolas&s o# the Laryn' ("(
Fig)re !"*/ ungal laryngitis: note white fungal plaques withmarginal erythema on midmembranous vocal folds.
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M . tuberculosis infections follow similar natural history
to pulmonary tuberculosis and most commonly present
as lesions in the posterior glottis. &atient factors include
increased prevalence in underdeveloped countries, areas of
over"crowding and communal living, and immunocom
promised populations. hile laryngeal infections present
with similar symptoms as pulmonary infections (cough,
hemoptysis, unintentional weight loss, fever, night sweats), patients may also present with laryngopharyngeal symp
toms such as dysphonia, dysphagia, and odynophagia.
&hysical examination can demonstrate exophytic masses
that mimic malignancy (;,%8). &athologic examination
demonstrates caseating granulomas that are pathogno
monic to M . tuberculosis infection. Treatment is targeted
with multidrug regimens with culture guidance, as multi
drug resistant M . tuberculosis strains are on the rise.
Other In#ections
@ess common infections of the larynx include leprosyand syphilis. M ycobacterial leprae and M ycobacterium lep
romatosis, the causative infectious agents of leprosy, cause
dramatic systemic and laryngeal epithelial changes. As
with the other laryngeal infections, patients can present
with variable severity in symptoms, with the most severe
being occult aspiration or complete upper airway obstruc
tion requiring tracheotomy (%,%%). The orld 'ealth
>rgani*ation recommends multidrug treatment with com
binations of dapsone and rifampin with possible adunc
tive clofa*imine.
3yphilis is caused by Treponema pallidum infection and
generally presents in stages. The primary stage generally
presents to the otolaryngologist as a painless oropharyngeal chancre. 5uring the secondary stage, patients can
present with laryngeal manifestations, including leu-o
pla-ia, exophytic mass( es), and very rarely, decreased
vocal fold mobility (%0,%2). 5iagnosis involves serologic
studies (venereal disease research laboratory or rapid
plasma regain) and/or dar-"field microscopy to visuali*e
the pathopneumonic spirochetes sampled from suspect
mucosa= lesions. The mainstay of treatment is penicillin.
or those patients with penicillin sensitivities, definitive
allergy testing and desensiti*ation may be required prior
to treatment.
I%ioathic 0lcerati1e Laryngitis
4diopathic ulcerative laryngitis (4
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frequency phonation, generali*ed dysphonia, decreased
vocal fold mobility, and
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7 Section IV: Laryngology Chater !": In#ection$ In#iltration$ an% Benign Neolas&s o# the Laryn' (4+
laryngeal edema (08). These symptoms are modulated by
the active status of the patientDs disease. Active rheuma
toid arthritis tends to present with a substantial laryngitis
with erythematous arytenoid mucosa (08"0%). hronic
rheumatoid arthritis also selectively targets the arytenoid
cartilages, but more specifically seems to affect the
cricoar ytenoid oint causing an-ylosis and possible oint
fixation (%). &atients may also present with rheumatoid
nodules, also -nown as bamboo nodes, which are focal
subepithe lial lesions, typically on the superior surface of
the mem branous vocal fold. Treatment of rheumatoid
arthritis relies upon medical management with
immunomodular and anti"inflammatory treatments.
Although outcomes data are sparse, surgical management
may be indicated to man age airway symptoms or to
udiciously remove rheumatoid nodules to improve
phonation (0%,00). (3ee hapter 9) Alternatively, serial
vocal fold steroid inections are a less invasive treatment
that may improve vocal outcome (02).
A&yloi%osis
Amyloidosis is an autoimmune condition characteri*ed
by extracellular deposition of fibrillar proteins in affected
tissue. @aryngeal involvement is rare and may not be
asso ciated with primary systemic amyloidosis. 'owever,
laryn geal amyloidosis may be present in conunction
with other systemic conditions such as multiple myeloma
(0#,0). &atients usually present with bul-y deposition of
amyloid protein with variable degrees of infiltration of
the vocal fold, paraglottic space, and the supraglottis.
&resenting fea tures include cough, dysphonia,dysphagia, and possible stridor. +iopsy is required for
diagnosis as amyloid has a pathognomonic apple green
birefringence after staining with ongo red (ig. $.2).
6eferral is needed to examine for underlying secondary
causes, such as systemic amyloi dosis. There are reports
of complete resolution with radia tion therapy, but this
treatment modality has not gained
Fig)re !"*5 Amyloidosis after ongo red staining: note applegreen birefringence with polarimetric filtered microscopy.
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8 Section IV: Laryngology Chater !": In#ection$ In#iltration$ an% Benign Neolas&s o# the Laryn' (4+
mainstream acceptance (0$). 3urgical intervention is
usu ally underta-en to address specific symptoms and
can improve vocal deficits. 6ecurrence is quite common
(09).
Relasing 6olychon%ritis
6elapsing polychondritis is characteri*ed by intermittentrecurrent episodes and inflammation of cartilaginous
struc tures. hile the ears and nose are most commonly
affected, the larynx can also become involved. 1arly
studies demon strate 2C of patients have laryngeal
involvement at pre sentation but that up to half of
patients eventually develop airway symptoms (0;).
6adiographic studies, such as mag netic resonance
imaging (M64) and computed tomography (T) can
identify cartilaginous changes. &atients may pres ent to
the otolaryngologist with ear, nasal, and/or airway
complaints such as exertional dyspnea or stridor.
&urulent chondritis of the laryngeal framewor- has been
described as a sequela of superimposed infection (28).
Medical man agement is paramount as maintenance
includes low dose corticosteroids and/or methotrexate.
5apsone has also shown to be beneficial (2). 3urgical
intervention may be indicated to secure the airway with
tracheotomy. A small case series of patients underwent
airway reconstruction to provide more long"term airway
stability (2%).
Syste&ic L))s Erythe&ato)s
@i-e rheumatoid arthritis, systemic lupus erythematous
(3@1) has a predilection for females. 4ts effects are not usu
ally limited to the larynx as roughly two"thirds of patients
never experience laryngeal symptoms. &atients can pres ent
with a wide variety of laryngopharyngeal complaints, which
include dysphonia and dyspnea. A study including %
patients with 3@1 found that had laryngeal abnormal ities
(20). &hysical signs ranging from edema or ulceration to
vocal fold paralysis can be seen on examination (22).
'owever, a direct causal relationship between 3@1 and the
above laryngeal pathology has yet to be demonstrated.
6e&hig)s an% 6e&higoi%
&emphigus and pemphigoid are related autoimmune con
ditions differentiated by the target of their autoantibod
ies. hile both conditions lead to a robust inflammatory
reaction that can possibly lead to epithelial inury, pem
phigus autoantibodies are directed against intraepithelialtargets while pemphigoid autoantibodies target subepithe
lial antigens. 4mmunofluorescence of tissue biopsy is
used to identify the characteristic autoantibodies for
definitive diagnosis.
&atients may pr esent with signs of disease within the
nasal cavity or the larynx. The prevalence of laryngeal
involvement seems to differ between the diseases for
un-nown reasons. >ne study demonstrated that % of
#0 (28C) patients with head and nec- manifestations of
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Fig)re !"*7 @aryngeal pemphigus in typical supraglottic location.
pemphigus had laryngeal involvement (2#). 'owever , a
separate study of pemphigoid patients demonstrated that
8 of 09 (%C) patients with head and nec- symptoms
had laryngeal involvement (2). >ther studies have dem
onstrated relatively similar prevalence in pemphigus
(2$). +oth pemphigus and pemphigoid appear to have a
predi lection for supraglottic mucosa (ig. $.#). 'igh"
dose cor ticosteroids are utili*ed to control active disease
and are decreased for maintenance therapy. >ther
immunomodu lators, such as a*athioprine,
cydophosphamide, and cydo sporine, have also been
utili*ed for medical management. 3urgical intervention is
limited to diagnostic biopsy and/ or airway intervention,such as tracheotomy or less invasive airway surgery
(dilation) to provide a stable airway.
Sarcoi%osis
3arcoidosis is an autoimmune condition defined patho
logically by noncaseating granulomas. &atients most
com monly affected are young adult African American
women. @aryngeal involvement is seen in 0C to #C of
cases and
Fig)re !"*! 3arcoidosis in typical supraglottic location.
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usually affects the supraglottis (ig. $.) (29).
@aryngeal complaints from sarcoidosis, such as
nonproductive cough and dyspnea, may be difficult to
differentiate from the pulmonary manifestations of the
disease. 5iagnosis of sarcoidosis relies on multiple
modalities as there are usu ally multiple organ systems
involved. The establishment of laryngeal sarcoidosis
relies on laryngoscopic evaluation, with hallmar- exam
findings of submucosal infiltration in the infraglottic, paraglottic space, and the supraglot tis. 4nvolvement of
the epiglottis leads to a distortion and thic-ening and
has been commonly referred to as a tur ban epiglottis.
3arcoidosis remains an elusive diagnosisE however,
biopsy of lesions classically reveals noncaseating
granulomas.
Treatment mainly relies on corticosteroids, but other
immunomodulators, such as a*athioprine, have also
been administered with good treatment success (2;).
3urgical intervention is limited to diagnostic biopsy,
excision of symptomatic lesions, or management of
obstructive airway lesions.
E'ternal Bea& Ra%iation
As the role of external beam radiation has increased for the
treatment of head and nec- malignancies, many of these
patients later present with laryngopharyngeal complaints,
such as dysphonia, dysphagia, and globus sensation post
treatment. 1lectron beam radiation induces gradual, dose
dependent fibrotic changes to include muscle atrophyand fibrosis in the larynx as well as desiccation of mucosa
(ig. $.$). ibrosis within the lamina propria can be
appreciated as decreased mucosa= pliability on strobos copy.
&atients will exhibit atrophy that is disproportionate to
their expected age"related vocal fold volume loss. !ocal fold
hypervascularity is a common finding due to prior vasculitis
incurred during radiation therapy. 4mprovement in voice is
commonly reported following laryngeal radia tion for early
laryngeal cancer, but voice outcomes associ ated with late
radiation fibrosis of the vocal folds remains
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11 Section IV: Laryngology Chater !": In#ection$ In#iltration$ an% Benign Neolas&s o# the Laryn' + + (4"
Fig)re !"*" 6adiation effects on the larynx: note global erythema, slight atrophy of muscular anatomy, and limited light reflexindicating decreased secretory function of the mucosa.
uncertain (#8,#). A prior report of postradiation vocal
quality suggests that vocal fold stripping or excisional
biopsy rather than limited biopsy for initial diagnosis and
continued tobacco smo-ing after treatment are signifi
cantly associated with an increased ris- of perceived
worse voice quality after treatment (#%).
As radiation oncologists develop more sophisticated
techniques to avoid collateral damage to uninvolved
struc tures, the extent of radiation changes may decrease.
BENI3N NEO6LASIA OF THE LARYNX
hen one excludes nonneoplastic vocal fold lesions,
such as vocal fold polyps, nodules, and cysts (see
hapter 9), benign tumors of the larynx are varied and
quite rare. 5iagnosis relies on thorough history with
appropriate examination and imaging.
Ha&arto&a
'amartomas are rare, benign lesions that can present as
congenital malformations or lesions later in life. They are
generally loosely organi*ed neoplasms with multiple
types of tissue, all of which are native to the affected
subsite of the larynx. 'amartomas can be incidentallyidentified or cause significant airway symptoms,
especially in a young child. &resentation and
symptomatology are related to the location of the
neoplasm, and hamartomas have been mostly commonly
identified in the supraglottis and sub glottis (#0,#2).
1xcisional biopsy is both diagnostic and curative if
resection is complete (##).
Chon%ro&a
hondromas are benign tumors consisting of
cartilaginous cells. They are slow"growing lesions that
do not metasta si*e, and they generally present as a
smooth, submucosal
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12 Section IV: Laryngology Chater !": In#ection$ In#iltration$ an% Benign Neolas&s o# the Laryn' + , (4"
lesion. @aryngeal chondromas may be difficult to differ
entiate from low"grade chondrosarcomas and clinically
follow a similar course. hile the bul- of these tumors
present within the posterior cricoid cartilage, lesions
have been found within other subsites of the larynx as
well as the hyoid bone (#,#$). &atients may be
relatively asymp tomatic, but lesions can cause airway
obstruction or exter nal nec- masses (#). T isgenerally the preferred imaging modality to define the
extent of the lesion (#9). 3urgical excision is the
treatment of choice for chondromas. 3urgery has been
traditionally performed via open procedures involving
laryngofissure, but, more recently, endoscopic ablation
techniques have been shown to be successful (#;).
omparative efficacy between open and endoscopic
surgical excision is un-nown.
Rha.%o&yo&a
6habdomyomas of the larynx are benign tumors
compris ing striated muscle. @aryngeal involvement is
the most common location for rhabdomyomas of the
head and nec- (8). These tumors present in variable
locations within the larynx and have been documented to
involve both intrinsic and extrinsic laryngeal
musculature (,%). 5iagnosis with biopsy or magnetic
resonance is indicated, and complete resection is
curative.
Resiratory 6aillo&atosis
Though primarily seen in the pediatric population, adult
onset recurrent respiratory papillomatosis (66&) is not an
uncommon presentation. or further information regard
ing uvenile onset 66&, please refer to hapter ;2.
aused by human papillomavirus ('&!) subtypes
and , 66& occurs most commonly at the level of
thevocal folds. The virus can be transmitted vertically or
by sexual transmission. 66& can present anywhere withinthe upper aerodigestive tract from the nasal vestibule to
the bronchi oles with a predilection for areas of transition
from pseu dostratified columnar to stratified squamous
epithelium.
@esions can be relatively small, noticeable only
because of resultant dysphonia from decreased vocal fold
muco sal wave propagation, dysphonia related to mass"
effect that impairs glottal closure, or variable degrees of
airway obstruction (igs. $.9 and $.;). Though benign,
they do have significant morbidity and have the potential
for malignant transformation (0,2). A recent study
includ ing #2 adults demonstrated that dysplasia was
identi fied in #8C of patients, and dysplasia was
diagnosed on biopsy specimens at an average of .%
months from initial diagnosis. >f the initial #2 patients, 0
progressed to carci noma in situ while patient
progressed to squamous cell carcinoma (2).
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13 Section IV: Laryngology Chater !": In#ection$ In#iltration$ an% Benign Neolas&s o# the Laryn' + / (4"
Fig)re !"*4 Adult 66& occluding anterior glottis, limiting phonation.
radiation therapy, cigarette smo-ing, and systemic immunosuppression have been implicated in malignant trans
formation ().
The verrucous papillomatous growth of the lesions are
pathognomonic. Though multiple treatment modalities
are available, conservative removal of disease is the first
line treatment. If cold instrumentation is to be utili*ed,
careful attention must be dedicated to only removing the
papilloma and leaving the superficial lamina propria undis
turbed. Ablation with >% or potassium titanyl phosphate
(FT&) lasers has also been shown to be a successful treat
ment modality for both initial and subsequent treatments
($). A great benefit of fiber"based laser treatment is that it
can be performed in an awa-e patient using a channeled
endoscope through which the fiber can be advanced. Awa-e
procedures decrease use of operative resources and elimi
nate the need and dangers of general anesthetic. 6egardless
of the surgical technique utili*ed, the physician must avoid
deepitheliali*ed surfaces in uxtaposition to avoid anterior
glottic webbing and/or posterior glottic stenosis.
Fig)re !"*( Adult 66& nearly occluding entire glottis.
hile surgical removal of lesions remains the first"line
treatment for 66&, other aduvant therapies have been
developed. idofovir is an antiviral shown to decrease
dis ease burden in both intralesional inection and inhaled
forms (9,;). +oth treatment modalities have been
shown safe, but hepatotoxicity has been identified with
the inected form. 4nterferon"alpha and indole"0"carbinol
(an extract found in cruciferous vegetables) have both
been used to control disease propagation ($8).
The
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Fig)re !"*+8 Adult supraglottic hemangioma. obblestone"appearing lingual tonsils are visibleat the inferior aspect of this image.The epiglottis is completely obscured by this hemangioma.
paucicellular areas, and the extracellular matrix tends to
be composed of 7cytologically bland spindle cells.7 The
reported cases all appear to be isolated lesions that pre
sented with dysphonia and cough ($$).6adiographicimag ing (er and M64) can delineate the full extent of the lesionin planning for surgical resection. 1xcision with margins is
advocated to minimi*e chance of recurrence ($9).
Sch9anno&a
3chwannomas arise from nerve sheath fibers and account
for less than % of all laryngeal tumors. The endoscopic
appearance may be mista-en for a laryngocele and com
monly appear as smooth submucosal mass within the
pyri form sinus or aryepiglotticspace ($;). &atients may
present
with globus sensation, dysphagia, dysphonia, and if large,airway obstruction (98). 4maging with er and/or M64help
to plan surgical resection. 'istopathologic examinationdemonstrates the classic Antoni A and Antoni + areas
seen with other schwannomas. The associated nerve was
not identified in the available case reports. 3ome patients
have postoperative dysphonia and vocal fold paresis,
possibly implying recurrent laryngeal involvement ($;).
3ran)lar Cell T)&or
Granular cell tumors can occur anywhere within the
body but are often seen within the head and nec- (9).
The larynx, however , is a rare location for these neo
plasms. They are neural in derivation and, within the
larynx, tend to grow slowly and isolate within the
vocal folds themselves. &resenting symptoms include
hoarse ness, strider , dysphagia, and cough. +iopsy
must be com pleted to evaluate for malignant neoplasm
as there is an association with pseudo"epitheliomatous
hyperplasia, which can mimic squamous cell
carcinoma. 3erologic staining of biopsy specimens will
yield positive results for 3"88, neuron"specific
enolase, vimentin, and 5 9 (9). omplete resection
with microlaryngeal phono surgical instruments and
principles can yield cure with good vocal outcome.
LARYN3OCELES AN SACC0LAR CYSTS
hile laryngoceles and saccular cysts are not neoplasms,
they present as benign appearing masses in the larynx.
The laryngeal saccule is a mucous gland containing
appendage that lies between the false vocal fold and the
thyroid carti lage. 4t is an out pouching of the normal
laryngeal ventricle and extends as a blind"ended sac posterolateral to the edge of the laryngeal surface of the
epiglottis. The function of the saccule is un-nown
although ithas been theori*ed that it may represent a
vestigial air sac. +oth laryngoceles and saccular cysts
involve expansion of the saccule to form a mass.
@aryngoceles by definition must have air contained
within their lumen, while saccular cysts are strictly fluid
filled masses.
@aryngoceles contain air due to patent communication
with the laryngeal lumen. urther classification of laryn
goceles depends on their location. They can be defined as
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Fig)re !"*++ ombined laryngocele. Axial T showing air"filleddilation of the saccule extending through the thyrohyoid mem
brane into the nec-.
internal, external, or combined. 4nternal laryngoceles are
strictly confined within the thyroid cartilage, external laryn
goceles lie exclusively outside the cartilaginous laryngeal
framewor-, and combined laryngoceles spanboth the inside
and outside of the thyroid cartilage (9%,90) (ig. $.).
3accular cysts are also classified according to their
loca tionE anterior and lateral. Anterior saccular cysts
appear as rounded fluid"filled masses emanating from
the ante rior portion of the ventricle and extend medially
into the lumen of the larynx (ig. $.%). They liesuperior to the glottal level at or near the anterior
commissure, and inter fere with phonation or airway
depending on their si*e. @ateral saccular cysts expand
within the paraglottic space and appear similar to internal
laryngoceles as a submuco sal fullness in the ventricular
fold.
Although the etiology of saccular masses is unclear,
they result from abnormal dilation of the saccule. 4t has
been suggested that those who routinely develop high
trans glottic pressures (glass blowers, trumpet players)
are at a higher ris- of developing laryngoceles. It is
thought that saccular cysts arise secondary to obstruction
of the saccular orifice as they have been found in patients
with laryngeal carcinoma or following an upper
respiratory tract infection (92). ongenital saccular cysts
can occur in infants and present as a wea- cry, stridor, or
cyanosis (90).
&atients with laryngoceles and saccular cysts report
symptoms consistent with a laryngeal mass: dysphonia,
stridor , chronic cough, a nec- mass, and occasionally
dys phagia. 3everity of symptoms depends on the si*e
and location of the lesion. 3mall or nonobstructing
lesions may be asymptomatic. The diagnosis is most
commonly made by physical examination including
transnasal or transoral laryngeal imaging and nec- exam.4n the case of
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Fig)re !"*+, Anterior saccular cyst. luid"filled mass arisingfrom the saccule and protruding into the laryngeal lumen.
anterior saccular cysts, a mass can be seen emanating from
the vestibule to the laryngeal lumen while lateral saccular
cysts and laryngoceles present as a submucosal mass in the
false vocal fold. 1xternal and combined laryngoceles can
present as a nec- mass that enlarges with valsalva. +oth
laryngoceles and saccular cysts can become acutely infectedto form a laryngopyocele or an infected saccular cyst.
3uper"infection can lead to rapid expansion and acute pre
sentation with worsening symptoms, fever, and occasion
ally, airway obstruction.
ine"cut T is a useful adunctive tool diagnostically.
The presence of air within the lesion differentiates laryn
goceles from saccular cysts. The location and extent of
the lesion can be accurately assessed with a fine"cut T
scan. 1ndoscopic excision of these lesions is the mainstay
of treatment and the recurrence rate is very low with
long term follow up (92).
S0--ARY
The larynx can be subect to infectious agents, inflamma
tory conditions, and neoplasia. The initial management
of the patient must be to ensure a stable, secure airway.
>nce the airway is ensured, a thorough history and physi
cal examination, followed by detailed laryngeal
endoscopy
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and directed biopsy, can usually narrow the differential
diagnosis and guide the physician to appropriate diagnos
tic testing. Treatment should address the patientDs symp
toms and ideally ensure both airway stability and future
vocal performance.
I Multiple infections, inflammatory, and benign
processes can affect the larynx. 1ach has its own
unique presentation and treatment considerations.
I 4nfectious laryngitis is most commonly viral in eti
ology, and should be initially treated with voice
rest and supportive measures in most cases.
+acterial, fungal, and mycobacterial infection is
considerably more rare.
I 4nflammatory and infiltrative processes of the lar
ynx can occur from egener granulomatosis (typi
cally subglottic involvement), sarcoidosis(typically supraglottic involvement), amyloidosis,
and auto immune processes (such as rheumatoid
arthritis, 3@1, and pemphigus/pemphigoid)
I The most common benign neoplasm of the larynx
is laryngeal papillomatosis. @aryngeal
chondromas, hamartomas, schwannomas,
fibromas, pleomor phic adenomas, and granular
cell tumors are far more rare.
REFERENCES
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