Benign lesions of the larynx
- Lesion
Benign laryngeal lesions change the voice: inflammation, nodules from voice strain, and HPV warts that keep coming back in children.
What it is
The larynx reacts to infection, irritants and voice abuse. Laryngitis is usually viral or from smoke, reflux or overuse; in children, croup and epiglottitis can block the airway. Vocal cord nodules and polyps are reactive lesions of the true cords with almost no cancer risk. Squamous papillomas are benign HPV 6 and 11 tumours that, when multiple and recurrent, form recurrent respiratory papillomatosis.
Structure
- Laryngitis: mucosal edema and congestion with inflammatory infiltrate.
- Nodule or polyp: smooth, sessile or pedunculated lesion a few millimetres across, covered by squamous epithelium over loose, myxoid or edematous stroma, sometimes with fibrin and hyaline change.
- Papilloma: soft, exophytic, raspberry-like growth with slender finger-like fibrovascular cores covered by orderly squamous epithelium, koilocytes.
- Epiglottitis: markedly edematous supraglottic tissue with neutrophils.
Step by step
- Repeated vocal trauma and vibration injure the subepithelial (Reinke) space of the cords.
- Edema, fibrin and hemorrhage organise into a nodule or polyp that stops the cords closing evenly: hoarseness.
- HPV 6 or 11 infects basal epithelium (in children via the birth canal) and drives benign papillary growth.
- The virus persists in normal-looking mucosa, so papillomas recur after removal.
- Viral or bacterial infection of the supraglottis or subglottis swells tissue where the child's airway is narrowest.
Benign laryngeal lesions
| Lesion | Cause | Typical patient | Key feature |
|---|---|---|---|
| Vocal cord nodules | Voice overuse | Singers, teachers | Bilateral, symmetric |
| Vocal cord polyp | Voice trauma, smoking | Adults | Usually unilateral |
| Squamous papillomatosis | HPV 6 and 11 | Children (also adults) | Multiple, recurrent |
| Croup | Parainfluenza virus | Young children | Subglottic swelling, barking cough |
| Epiglottitis | H. influenzae type b, streptococci | Unvaccinated children, adults | Cherry-red epiglottis, drooling |
Clinical notes
- Hoarseness lasting more than a few weeks warrants laryngoscopy to exclude cancer.
- Child with papillomatosis: repeated surgical removal, risk of airway obstruction and, rarely, spread to the lungs.
- Suspected epiglottitis: do not examine the throat with a tongue depressor; secure the airway.
Test yourself
Think of the answer, then tap the question to see it.
How do vocal cord nodules and polyps usually differ?
Nodules are bilateral and symmetric, from chronic voice use; polyps are usually unilateral.
Which HPV types cause laryngeal papillomas?
Low-risk HPV types 6 and 11.
Which virus causes most cases of croup?
Parainfluenza virus.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: HPV (MedlinePlus, US National Library of Medicine, 2025); Laryngeal Cancer (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.