A professional singer presents with painless progressive hoarseness. Laryngoscopy reveals bilateral symmetrical smooth, gelatinous swellings on the free edge of both vocal cords at the junction of the anterior one-third and posterior two-thirds. What is the most likely diagnosis?

• A Vocal cord polyp
• B Reinke's oedema
• C Contact granuloma of the vocal process
• D Vocal cord nodules (singer's nodules) ✓

Explanation

Vocal cord nodules (singer's or teacher's nodules) are bilateral symmetrical fibrous thickenings at the junction of the anterior one-third and posterior two-thirds of the vocal cords — the point of maximum vibration amplitude. They result from chronic vocal abuse. Polyps are usually unilateral and pedunculated. Reinke's oedema is diffuse bilateral subepithelial oedema associated with smoking. The location at the one-third/two-thirds junction is pathognomonic for nodules.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.