Author(s)
Celeste S. Kim, BS
Ido Badash, BA
William Z. Gao, MD
Karla O'Dell, MD
Michael M. Johns III, MD
Affiliation(s)
USC Caruso;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to recognize the presentation, disease course and most commonly utilized diagnostic and treatment modalities for the management of idiopathic ulcerative laryngitis. Objectives: Idiopathic ulcerative laryngitis (IUL) is a rare disorder characterized by chronic ulceration in the mid-membranous portions of vocal folds. Etiology and treatment are poorly understood. We aim to survey laryngologists on IUL in order to better understand diagnosis and treatment of this unusual condition. Study Design: Survey of academic laryngologists. Methods: A survey was sent to 149 fellowship trained laryngologists at U.S. academic institutions. Questions assessed clinical experiences with IUL. Results: Response rate was 68.5%. All had encountered IUL in their practice. 57.8% report having seen 1-10 cases, 22.6% report 11-20 cases, and 19.6% report >20 cases over their career. Dysphonia and severe cough were the two co-occurring primary presenting symptoms reported. Most diagnose based on laryngeal videostroboscopy (94%). Fungal/bacterial cultures and operative biopsy had been performed by approximately 30% of respondents with occasional candidiasis reported but otherwise negative/nonspecific results. Common therapies used were empiric: antireflux therapy (94%), voice/laryngeal rest (93%), and oral steroids (82%). Less commonly used therapies were antiviral and antifungal medication. No specific treatment was reported to be particularly effective. Resolution was reported to occur slowly over weeks to months. While recurrences occurred rarely (52.1%) or never (33.3%), permanent sequelae were reportedly common: vocal cord stiffness (89.6%) and dysphonia (83.9%). Conclusions: IUL is a rare disorder of unknown etiology. Diagnosis is typically made with laryngeal videostroboscopy alone. Spontaneous resolution occurs slowly over weeks to months. Laryngologists empirically treat with antireflux therapy, voice rest, cough suppression therapy, and oral steroids. Further research is necessary to improve understanding of IUL.