Laryngology and Voice Disorders
Laryngology and Voice Disorders
This domain tests dysphonia evaluation, benign vocal fold lesions, laryngopharyngeal reflux, and red flags for malignancy. The exam emphasizes laryngoscopy and voice therapy before surgery.
Core rules
- Dysphonia lasting more than 4 weeks, especially with smoking, hemoptysis, odynophagia, or neck mass, requires laryngoscopy.
- Vocal fold nodules are bilateral and related to phonotrauma; voice therapy is first-line. Polyps may be unilateral and also improve with therapy before excision.
- Muscle tension dysphonia is a diagnosis of exclusion; laryngoscopy shows supraglottic squeezing without a structural lesion.
- Spasmodic dysphonia is treated with botulinum toxin injections; voice rest is not a proven treatment for most benign lesions.
- Laryngeal cancer may present as leukoplakia, erythroplakia, or an irregular mass; persistent suspicious lesions require biopsy.
Worked example
A 34-year-old teacher has 3 months of hoarseness and vocal fatigue. Laryngoscopy shows bilateral mid-membranous swellings consistent with nodules. The best initial plan is voice therapy, hydration, and amplification, with reassessment before surgery. The reasoning is that nodules reflect phonotrauma and often regress with behavioral change.
Traps
Do not recommend absolute voice rest for weeks. Do not treat all dysphonia as reflux. Do not rely on symptoms alone to distinguish reflux from malignancy. Do not biopsy leukoplakia without visualizing the whole larynx and assessing aerodigestive symptoms.