Various vocal cord benign lesions such as vocal nodule, vocal cord polyp, papilloma, vocal cord submucosal cyst, submucosal hematoma, contact ulcer and granuloma, Renke's layer edema, hemangioma, neurofibroma, laryngeal amyloidosis, etc. The above lesions can also be characterized by hoarseness, accompanied by aggravation of hoarseness, throat discomfort and sore throat. However, the above benign vocal cord lesions have a long history of hoarseness, generally more than 3 months. Indirect laryngoscope, fibrolaryngoscope or electronic laryngoscope can show the corresponding vocal cord lesions, and combined with pathological examination, the diagnosis can be confirmed.
2. Precancerous lesions of larynx
Laryngeal precancerous lesions refer to a group of diseases that are more likely (but not necessarily) to become cancerous than normal laryngeal mucosa, including laryngeal leukoplakia, laryngeal hypertrophy, adult laryngeal papilloma, chronic laryngitis with atypical hyperplasia of mucosal epithelial cells, laryngeal keratosis and so on. Laryngeal precancerous lesions usually have a long course of disease, and the symptoms can be gradually aggravated. Indirect laryngoscope, direct laryngoscope or fibrolaryngoscope can all show the corresponding laryngeal lesions, which can be diagnosed by pathological examination, but it should be differentiated from acute laryngitis at the initial stage.
3. Leukoplakia of larynx
It refers to the flaky keratoproliferative lesions on the laryngeal mucosa, which are more common in vocal cords. It may be related to smoking, improper use of sound, chronic inflammatory stimulation or vitamin deficiency. The main pathological changes were laryngeal epithelial hyperplasia with incomplete keratinization and mild submucosal hyperplasia. The main symptom is hoarseness. Under laryngoscope, there are white patches with flat surface in the front and middle third of the leading edge of vocal cords, which are limited in scope and difficult to remove, and the vocal cords are active well.
4. Cartilage hypertrophy
This is a kind of hypertrophic laryngitis. The main pathological changes were epithelial hyperplasia, increased cell layer and keratinization of surface cells in the back of larynx. The connective tissue under the mucosa epidermis thickens, forming papillae and extending into the epidermis. The boundary between epidermis and connective tissue under it is clear, and there is no cell infiltration. The main clinical manifestations are hoarseness and dry throat.
5. Adult laryngeal papilloma
It is a tumor from laryngeal epithelial tissue, which is papillary from multi-layer squamous epithelium and connective tissue below it to the surface, easy to become malignant, and characterized by hoarseness and dyspnea in the late stage. During the physical examination, you can see that there are new creatures in the throat, and their appearance is rough and red.
6. Chronic laryngitis with atypical hyperplasia of mucosa
The main histological changes are epithelial hyperplasia and degeneration, which are basically the same as laryngeal hypertrophy, but with different degrees. The main clinical symptoms are hoarseness and throat discomfort. Physical examination showed that the laryngeal mucosa was widely thickened, chronic congestion and generally symmetrical, especially in the arytenoid cartilage area. The vocal cords are obviously thick, with gaps near the midline and incomplete closure. Ventricular bands are often involved and thickened, covering some vocal cords. Epiepiglottic folds can also be thicker than normal.
7. Malignant tumor of larynx
Laryngeal malignant tumors include laryngeal squamous cell carcinoma, adenocarcinoma, basal cell carcinoma, poorly differentiated carcinoma and lymphoma, among which laryngeal squamous cell carcinoma (laryngeal carcinoma) is the most common, accounting for about 90%. Laryngeal malignant tumors also show hoarseness and throat discomfort at the early stage of onset. Physical examination found that there were new organisms in the throat, and pathological examination was needed for further diagnosis.
Laryngeal cancer can be divided into supraglottic type, glottic type and subglottic type according to the site of occurrence. According to morphological observation, laryngeal cancer can be divided into ulcer infiltration type, cauliflower type, nodular type and mixed type. The main symptom of early laryngeal cancer is hoarseness. With the development of the disease, foreign body sensation in the throat, cough, dysphagia and cervical lymph node metastasis may occur. During physical examination, new organisms can be found in the throat, and the surface is not smooth, which may affect the vocal cord movement with the progress of the disease. The invasion and metastasis of laryngeal cancer to surrounding tissues and organs were determined by CT and MRI examination of larynx. Ultrasound can observe lymph node metastasis and its relationship with surrounding tissues. Finally, the diagnosis should be confirmed by pathological examination.
8. Vocal cord movement disorder
Under normal circumstances, vocal cords are moved and closed by laryngeal muscle movement. This series of complex and coordinated movements are dominated by the recurrent laryngeal nerve, and the vocal cords can be in different positions according to different physiological needs of the larynx. When there are nerve paralysis, laryngeal myopathy, cricoarytenoid arthritis or cricoarytenoid joint dislocation that dominate vocal cord movement, the vocal cord movement ability will be limited to varying degrees, and vocal cord displacement and vocal cord paralysis will occur at the same time, which is characterized by hoarseness. Indirect laryngoscope, fibrolaryngoscope or electronic laryngoscope can show vocal cord dyskinesia. When inhaling, the vocal cords can't abduct, but the contralateral vocal cords abduct normally, and the glottis can still be closed when vocalizing. When bilateral vocal cord paralysis occurs, the movement of bilateral vocal cords is limited, and patients will immediately have severe breathing difficulties. According to the patient's medical history, signs and throat examination, the diagnosis can be confirmed.
9. Special inflammation of larynx
Laryngeal diphtheria is an acute respiratory infectious disease, which is mainly transmitted by respiratory droplets or contact with infected people. The pathogen is Corynebacterium diphtheriae. Laryngeal diphtheria can also be manifested as hoarseness, sore throat, cough and other symptoms. During the examination, a thick gray false membrane can be seen in the throat. At the initial stage of onset, the pseudomembrane in larynx is atypical, but the condition of laryngeal diphtheria develops rapidly, accompanied by systemic poisoning symptoms, such as fever, fatigue, nausea and vomiting, headache, etc. In severe cases, neck swelling occurs due to cervical lymphadenitis, such as "bovine neck". Laryngeal diphtheria is more common in children, but rarely occurs in adults. It is feasible to further diagnose suspicious cases by throat swab and bacterial culture.
10. Adam's apple
The pathogen is Mycobacterium tuberculosis, and primary laryngeal tuberculosis is rare, which is mostly transmitted by open tuberculosis through the lower respiratory tract. The main symptom is hoarseness, which is gradually aggravated, often accompanied by sore throat and aggravated when swallowing. Indirect laryngoscope, fibrolaryngoscope or electronic laryngoscope can show that the laryngeal mucosa is pale, the arytenoid cartilage area or one vocal cord is partially congested, there may be insect-eaten ulcer with irregular edges, granulation hyperplasia at the bottom, epiglottis and arytenoid cartilage show swelling and thickening. If the lesion involves arytenoid joint, it can be diagnosed by sputum acid-fast bacilli examination, chest X-ray examination, tuberculin test and biopsy.