A 34-year-old woman who was intubated for 10 days in intensive care now has persistent hoarseness and pain on phonation. Laryngoscopy shows a smooth, telangiectatic, pedunculated mass over the vocal process of the left arytenoid. She also reports chronic heartburn. What is the most likely diagnosis?

• A Vocal cord polyp of Reinke oedema type
• B Intubation-related arytenoid dislocation
• C Vocal process granuloma (contact ulcer) ✓
• D Early glottic squamous cell carcinoma

Explanation

Granulomas arise over the vocal process of the arytenoid where thin perichondrium overlies cartilage; trauma from intubation, forceful coughing, or habitual throat clearing combined with laryngopharyngeal reflux produces an exuberant granulomatous response. Location over the vocal process is the discriminating finding: Reinke oedema and polyps involve the mid-membranous cord, carcinoma is usually seen in older smokers, and arytenoid dislocation would show a fixed cord rather than a mass.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.