Author(s)
Ravi R Shah
Natasha A. Mirza
Affiliation(s)
University of Pennsylvania; PA
Abstract:
Objective: We report the case of a patient with hoarse voice and massive bilateral supraglottic masses obscuring her glottis.Method: A 68-year-old female with no history of intubation or gastroesophageal reflux presented with four months of persistent hoarseness after a one week hospitalization for pneumonia. She had quit smoking 30 years prior, and her medical history was only notable for hypertension and diabetes. She reported mild throat clearing and mucus but denied heartburn, globus sensation, cough, dyspnea, and dysphagia. Her voice was raspy. Nasopharyngolaryngoscopy revealed three giant pedunculated supraglottic masses obscuring her true vocal folds. The differential for this patient included recurrent respiratory papillomatosis, granuloma, squamous cell carcinoma, and other rare benign and malignant laryngeal tumors. The masses were resected under microdirect laryngoscopy and sent for histopathology.Results: Pathology demonstrated squamous mucosa with underlying granulation tissue, and mixed acute and chronic inflammation, consistent with laryngeal granuloma.Conclusion: The etiology of laryngeal granuloma can typically be attributed to either endotracheal intubation, vocal abuse, or gastroesophageal reflux disease (GERD) with laryngopharyngeal reflux. There is a strong male predominance, except in cases due to intubation, where incidence is higher in women. Although the vast majority of laryngeal granulomas in females are due to intubation, this case demonstrates the spontaneous development of multiple granulomas in a female with no inciting factors. Silent reflux may have played a causative role, but the disparity between the massive lesions and relatively asymptomatic reflux highlights the need for further research in the pathophysiology of laryngeal granuloma.