Vocal process granuloma/ contact ulcers are diagnosed based on clinical criteria using fiberoptic laryngoscopy.  These lesions are initiated by injury to the mucosal lining over the vocal process by endotracheal intubation or phonotrauma, and are perpetuated by active laryngopharyngeal reflux disease.  Successful treatment involves aggressive anti-reflux treatment with PPIs, inhaled corticosteroids, and in some cases speech therapy and/or vocal fold augmentation.  Full resolution of these lesions may take months, especially in the case of non-intubation granulomas.

Pharyngitis is one of the most common conditions encountered in outpatient clinical practice. Most cases are self-limited and caused by respiratory viruses. It is important to recognize and treat bacterial pharyngitis to prevent potential complications.

Aspiration is commonly associated with dysphagia. The consequences of aspiration depend on patient comorbidities, the volume of aspirated material and the chronicity of symptoms. Early detection and appropriate management of aspiration may decrease complications. This module provides a comprehensive framework for the diagnosis and management of aspiration and its sequelae.

Zenker’s diverticulum is a pulsion diverticulum through Killian’s triangle that develops after many years of increased intraluminal pressure in the hypopharynx. This results in dysphagia to solids, regurgitation, and occasionally weight loss, aspiration, and pneumonia, which is especially dangerous as this affects mostly patients over age 70. Treatment includes methods aimed primarily at dividing the cricopharygeus.

Voice problems are frequently encountered in an otolaryngology practice, with professional speakers representing a large percentage of the caseload. A recommended treatment method is voice therapy. A certified speech pathologist with special training in voice disorders is the best trained professional to complete voice therapy. Many approaches to voice therapy are available. Optimal therapy design fits an individual patient’s needs.

Acute airway management requires clear communication between health care providers to develop a plan with multiple agreed upon contingencies. Development of this tiered approach to establishing a safe airway also requires utilization of a baseline algorithm and the flexibility to rapidly apply patient-specific considerations. The otolaryngologist maintains the most intimate knowledge of the altered airway and is in sole possession of the full range of skills required to definitively address the difficult airway.

Granulomatous diseases of the larynx are generally relatively rare systemic diseases with manifestations in the larynx and other sites in the head and neck. When they affect the larynx, this can result in dysphonia and dyspnea, and less likely dysphagia. While common diseases have predilection for laryngeal subsites (with sarcoidosis generally involving the supraglottis, amyloidosis the glottis, and granulomatous with polyangiitis the subglottis), in practice each pathology can affect each subsite.

Laryngeal dystonias involve involuntary movements of the laryngeal muscles, and subtypes include adductor spasmodic dysphonia, abductor spasmodic dysphonia, and laryngeal respiratory dystonias. These can present with vocal tremor. The anatomy and pathophysiology are poorly understood. Incidence is significant higher in females. The treatment of choice is injections with Botox into the intrinsic and/or extrinsic laryngeal musculature, depending on the specific presentation. Voice therapy can be a good coadjuvant treatment in some cases.

Glottic, Subglottic and Tracheal Stenosis are a group of obstructive fibrotic diseases in the larynx and trachea (collectively termed laryngotracheal stenosis, i.e. LTS). LTS can occur without known antecedent injury (idiopathic subglottic stenosis, iSGS). It also can accompany collagen vascular disease (e.g. Wegener’s Granulomatosis: GPA, Relapsing Polychondritis: RPC), follow iatrogenic injury (e.g., endotracheal intubation), or result from myriad less-frequent causes.

Laryngeal or voice tremor can occur independently or as a manifestation of several neurological conditions including essential tremor, Parkinson disease, and so-called Parkinson-plus syndromes. Around 25-30% of patients with essential tremor will have laryngeal involvement, and about half of cases are inherited in autosomal dominant fashion with 100% penetrance. Patients present in a bimodal distribution in the 2nd and 6th decades, with 10% of patients over 65 having symptoms.