EN4.41 | Benign Inflammatory Paralytic Laryngeal Disorders — Summary & Reflection

KEY TAKEAWAYS

Benign laryngeal diseases span three main categories. Benign structural lesions include vocal cord nodules (bilateral, junction, professional voice users — voice therapy first), polyps (unilateral, haemorrhagic or oedematous — microlaryngoscopy), Reinke's oedema (bilateral entire cord, smoking — cessation + phonomicrosurgery), contact granuloma (posterior arytenoid, reflux — anti-reflux therapy), and papilloma (HPV 6/11, commonest benign laryngeal tumour — CO2 laser excision, tends to recur). Inflammatory conditions include acute laryngitis (viral, self-limiting — voice rest), acute epiglottitis (Hib, supraglottic emergency, thumb sign on lateral X-ray — DO NOT examine throat, secure airway then IV antibiotics), croup (parainfluenza, subglottic, steeple sign on AP X-ray — dexamethasone ± nebulised adrenaline), diphtheria (Corynebacterium diphtheriae, grey pseudomembrane — antitoxin immediately + penicillin), and chronic laryngitis (leukoplakia = biopsy mandatory). Laryngeal paralysis (detailed in EN4.40): unilateral = breathy voice and aspiration; bilateral = stridor. The overriding safety rule: in any child with suspected epiglottitis, securing the airway takes absolute priority before any other intervention.

REFLECT

India's vaccination coverage remains below 90% for Hib and DTP in several states, meaning that epiglottitis and diphtheria — diseases that most ENT trainees in high-income countries have never seen — remain part of the real differential diagnosis in a district hospital in India. Reflect on how the introduction of a vaccine (Hib in the national immunisation schedule) completely transformed the epidemiology of a life-threatening ENT emergency. Now think about the children who do not receive the vaccine — either due to access barriers, parental hesitancy, or systemic failures. As a future clinician, you will be the last line of defence for these children. What would you need to remember from this SDL to manage a child with suspected epiglottitis in a resource-limited district hospital where there is no anaesthetist available? What is the minimum equipment you would need, and what is the single action you must NOT take?