Benign Lesions of the Vocal Folds: Histopathology and Phonotrauma

TLDR

Benign vocal fold lesions display diverse appearances, and histopathologic examination can clarify their true diagnosis. The study proposes a pathogenetic model of benign vocal fold lesions that links histopathologic findings with trauma mechanisms. Single‑blind histologic examination of 74 patients’ vocal folds was used to develop this model. Individual histologic features alone cannot distinguish clinical entities, but specific combinations increase diagnostic likelihood, and ultrastructural analysis revealed entity‑unique basement membrane‑like material in polyps, Reinke edema, and nodules.

Abstract

Benign lesions of the vocal folds have various appearances. Histopathologic examination might provide the true diagnosis. Therefore, histologic slides of 74 patients (92 vocal folds) with clinically well-defined diagnoses were single-blind examined by a pathologist. Single histologic features did not differentiate between different clinical entities, but combinations make some diagnoses more likely than others. Ultrastructural examination of submucosal vessels in the three most common clinical entities (polyps, Reinke edema, and vocal fold nodules) showed an entity-unique pattern of abnormal increase of layers of basement membrane—like material. A potential pathogenetic model of benign lesions of the vocal folds is presented, employing a combination of histopathologic findings and their possible relations with various forms of trauma inducing and maintaining these lesions.