A 40-year-old woman, extubated 6 weeks ago after prolonged ICU ventilation, presents with persistent hoarseness and pain on phonation. Endoscopy shows a smooth, sessile, reddish lesion over the posterior one-third of the vocal cord at the vocal process of the arytenoid. The most likely diagnosis is:
- A Vocal nodule
- B Reinke's oedema
- C Intubation granuloma ✓
- D Vocal cord polyp
Correct answer: C. Intubation granuloma
Explanation
Prolonged or traumatic intubation causes mucosal injury over the vocal process of the arytenoid, where the mucosa is thin over cartilage, leading to granulation tissue that matures into an intubation (contact) granuloma at the posterior third of the cord. Voice therapy and acid suppression often allow regression; excision risks recurrence. Vocal nodules and polyps arise at the junction of the anterior and middle thirds from voice abuse, and Reinke's oedema is diffuse cord swelling in smokers.
Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.