I) Vocal cord polyps, nodules and granulomas: Vocal cord polyps develop due to phonatory trauma (overuse or misuse of the voice), GERD, smoking, and chemical or mechanical injury. They’re typically unilateral and are usually found on the membranous vocal cord. They present with hoarseness, vocal fatigue, a rough or scratchy voice, and mechanical symptoms such as a sensation of a lump in the throat. The symptoms of vocal cord nodules and granulomas are similar to those of vocal cord polyps. Histology shows increased fibronectin and type IV collagen, decreased hyaluronic acid, epithelial keratosis, and thickening of the basal membrane.

Vocal cord nodules are bilateral and appear anteriorly on the vocal cords. They’re caused by voice abuse such as yelling and shouting.

Vocal cord granulomas are seen posteriorly and are associated with intubation trauma and GERD.

II) Nasal polyps: Nasal polyps are benign growths that arise from the mucosa of the nasal sinuses or the nasal cavity. Chronic nasal inflammation leads to their formation. They’re more common in individuals with allergies, asthma, low Vit D levels, cystic fibrosis, HLA-A74, and aspirin sensitivity. They present with nasal obstruction, watery rhinorrhea, postnasal drip, and anosmia or hyposmia. Nasal polyps appear as grey, single or multiple polypoid masses prolapsing into the nasal cavity. They’re covered with pseudostratified respiratory epithelium or ciliated columnar epithelium and are composed of loose connective tissue, eosinophils, mucus-secreting glands, and capillaries. Increased eosinophils in nasal secretions and raised serum IL5 levels are seen. Diagnosis can be made with CT scan and endoscopy.

III) Respiratory (laryngeal) papillomatosis: This condition is characterized by the growth of multiple, wart-like papillomas in the respiratory tract. The most common locations are the larynx and vocal cords. It’s associated with HPV 6, 11, 16, and 18. An infected mother can pass HPV to her child during pregnancy or birth. Risk factors include active genital warts in the mother during pregnancy and childbirth, smoking, radiation exposure, oral sex, and GERD.

These are benign growths, but they carry a high risk of mechanical airway obstruction. They present with hoarseness, a raspy voice, stridor (inspiratory or biphasic), loss of voice, choking, chronic cough, dysphagia, dyspnea, and failure to thrive (in children). There’s a small risk of malignant transformation of a papilloma to squamous cell carcinoma. Lesions are recurrent and may recur after surgical removal.