PBL ENT
A 50 year old male teacher by profession comes to your OPD with complaints of intermittent
change of voice for past 2 months.
He also gives history of smoking for the last 20 years.
He had got treatment from local GP but no improvement in his symptoms.
On examination indirect laryngoscopy failed to show any ulcerative or fungative lesion.as the
patient is Neck examination is unremarkable.
Fibreptic examination reveals raised smooth lesion at junction of antenior 1/3rd and postenior
2/3rd of true vocal cords .
Buth vocal cords are mobile.
Treatment:- Tab. Serratiopeptidase BD
- Cap. Omeprazole 20mg 1 OD
- Steam inhalation twice daily
LEARNING GOALS:
1) What is the pathophysiology of diagnosis?
Excessive voice use or vocal abuse causes inflammation and edema of the vocal cords where
they meet frequently together during phonation. This inflamed tissue is later on replaced by
hyalinization and fibrous tissue to form the vocal nodules. Change of voice occurs as vocal cords
cannot meet together during process of phonation.
2) What is the probable diagnosis?
Vocal nodules
3) What are the clinical features?
Symptom
Change of voice (Hoarseness), vocal fatigue and pain in neck on prolong use of voice
Signs
Hoarseness, on FODL nodules are found bilaterally at the junction of upper and middle third of
vocal cords
4) What are the differential diagnoses?
Reinke’s edema, Vocal polyp, vocal cyst, Vocal cord neoplasm
5) What treatment will you offer to the patient?
General treatment:
Voice rest
Speech therapy
Cessation of smoking
Medical:
Proton pump inhibitors
Surgical:
Microsurgery
LASER excision
Voice rest
Speech therapy