A Comprehensive Analysis of Benign Vocal Fold Lesions Causing Hoarseness of Voice and Our Experience with Cold Knife Endolaryngeal Surgery in a Tertiary Healthcare Centre

  • Aparaajita UpadhyayEmail author
  • Asiya Kamber Zaidi
  • R. K. Mundra
Original Article


Benign vocal fold lesions (BVFL) frequently affect the general population and cause significant hoarseness by interfering with daily communication. Healthcare for low income groups in India is all about affordability and availability without giving up on quality and providing maximum satisfaction. (1) To analyse over a period of 4 years, the demographics, clinical profile, diagnostics and management options of BVFL. (2) To assess the diagnostic potential of rigid laryngoscopy in diagnosing these lesions. (3) Cold knife endolaryngeal surgery as a cost effective, satisfactory and efficient treatment modality to tackle majority of these BVFL. A prospective cross sectional study over a period of 4 years from 2013 to 2017. 114 patients presenting with hoarseness of voice were evaluated by indirect laryngoscopy followed by video laryngoscopy and stroboscopy in the department of ENT, MYH Hospital Indore (M.P.). Male:female ratio of 1.59:1 with male predominance (61.4%) and maximum incidence in the third decade (32%). All cases presented with hoarseness (100%) while vocal fatigue (63%) was the most common associated complaint followed by foreign body sensation (60%). Housewives (32%) were most commonly involved non professional group while teachers (13%) constituted the most common group of professionals. Laryngitis (26%) involving bilateral vocal folds diffusely was the most common finding followed by vocal fold sulcus (18%) and vocal fold cysts (14%). The duration of symptom was 6 months to 1 year in 52% patients. The positive predictive value for rigid laryngoscopy was 100% for vocal nodules, arytenoid granulomas and anterior glottis web. Out of 114 patients, 66 patients improved on conservative management while 48 patients underwent cold knife endolaryngeal surgery. As per the GRBAS scale to assess the post therapeutic prognosis, all had good outcome of voice with only two recurrences due to patient non compliance. In this rapidly evolving era of sophisticated lasers which is a costly affair that requires skilled personnel and safety precautions, the prime goal in a government run setup has always been to provide affordable and quality healthcare to the common man. Cold knife endolaryngeal surgery is a simple, cost effective and efficient way to tackle most of these lesions and hence helps in achieving this goal.


Benign vocal fold lesions (BVFL) Hoarseness Cold knife endolaryngeal surgery (CKELS) 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Schwartz SR et al (2009) Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg 141(3 Suppl 2):S1–S31CrossRefGoogle Scholar
  2. 2.
    Brodnitz FS (1963) Goals, results and limitations of vocal rehabilation. Arch Otolaryngol 77:148–156CrossRefGoogle Scholar
  3. 3.
    Maran AGD (1982) Voice problems, logan turners diseases of ENT. Laryngology 1:372Google Scholar
  4. 4.
    Bastian Robert W (2005) Benign vocal fold mucosal disorders Cummings otolaryngology head and neck surgery, vol 3, 4th edn. Mosby Elsevier, Philadelphia, p 2150Google Scholar
  5. 5.
    Kleinsasser O (1982) Pathogenesis of vocal cord polyps. Otol Rhinol Laryngol 91:378–381CrossRefGoogle Scholar
  6. 6.
    Muniraju M, Vidya H (2017) Clinical study of benign lesions of larynx. Int J Med Res Rev 5(03):229–234. CrossRefGoogle Scholar
  7. 7.
    Siddapur GK et al (2015) Comparative study of benign vocal fold lesions in a tertiary health centre. Int J Otorhinolaryngol Head Neck Surg 1(2):65–68CrossRefGoogle Scholar
  8. 8.
    Saha PP et al (2017) A clinicopathological study of benign lesions of the vocal fold. IOSR J Dent Med Sci 16:09–12CrossRefGoogle Scholar
  9. 9.
    Buche RA, Garud SH, Jaiswal SA, Chamania GA (2016) Benign lesions of larynx—a clinicopathological study. IOSR J Dent Med Sci 15:09–17. CrossRefGoogle Scholar
  10. 10.
    Singhal P, Bhandari A, Chouhan M, Sharma MP, Sharma S (2009) Benign tumors of the larynx: a clinical study of 50 cases. IJLO 61(1):26–30Google Scholar
  11. 11.
    Chopra H, Kapoor M (1997) Study of benign glottic lesions undergoing microlaryngeal surgery. Indian J Otolaryngol Head Neck Surg 49:276–279CrossRefGoogle Scholar
  12. 12.
    Harding SM, Richter JE (1997) The role of gastroesophageal reflux in chronic cough and asthma. Chest 111:1389–1402CrossRefGoogle Scholar
  13. 13.
    Koufman JA (1991) The otolaryngologic manifestations of gastroesophageal reflux disease. Laryngoscope 101(Suppl. 53):1–78CrossRefGoogle Scholar
  14. 14.
    Parikh N (1991) Aetiology study of 100 cases of hoarseness of voice. Indian J Otolaryngol Head Neck Surg 43(2):71–73Google Scholar
  15. 15.
    Banjara H, Varsha M, Singh D, Gupta A (2011) Hoarseness of voice: a retrospective study of 251 cases. Int J Phonosurg Laryngol 1(1):21–27CrossRefGoogle Scholar
  16. 16.
    Wani AA, Rehman A, Hamid S, Akhter M, Baseena S (2012) Benign mucosal fold lesion as a cause of hoarseness of voice—a clinical study. Otolaryngology 2:120. CrossRefGoogle Scholar
  17. 17.
    Batra K, Motwani G, Sagar PC (2004) Functional voice disorders and their occurrence in 100 patients of hoarseness as seen on fibreoptic laryngoscopy. Indian J Otolaryngol Head Neck Surg 56(2):91–95PubMedPubMedCentralGoogle Scholar
  18. 18.
    Saudi S (2013) Benign lesions of the vocal cards in different ages: prospective study of 60 cases. J Med Sci Technol 2(3):130–134Google Scholar
  19. 19.
    Soni HD, Gandhi S, Goyal M, Shah U (2016) Study of clinical profile of benign laryngeal lesions. Int J Med Sci Public Health 5:656–660CrossRefGoogle Scholar
  20. 20.
    Baitha S, Raizada RM, Kennedy AK, Puttewar MP, Chaturvedi VN (2004) Predisposing factors and etiology of hoarseness of voice. Indian J Otolaryngol Head Neck Surg 56(3):186–190PubMedPubMedCentralGoogle Scholar
  21. 21.
    Barry DW, Vaezi MF (2010) Laryngopharyngeal reflux: more questions than answers. Cleve Clin J Med 77:327–334CrossRefGoogle Scholar
  22. 22.
    Satheesh S, Yamuna R, Premnath N (2015) Videolaryngoscopic surgey in benign laryngeal lesions-our experience. J Evid Based Med Healthc 2(48):8364–8367. CrossRefGoogle Scholar
  23. 23.
    Sharma M, Kumar S, Goel M, Angral S, Kapoor MA (2015) Clinical study of benign lesions of larynx. Int J Oral Health Med Res 2(2):22–28Google Scholar
  24. 24.
    Epstein S, Winston P, Friedmann I, Ormerod FC (1957) The vocal cord polyp. J Laryngol 71:673–688CrossRefGoogle Scholar
  25. 25.
    Nerurkar N, Garg S (2011) Correlation between rigid laryngoscopy and histopathology of laryngeal lesions at our voice clinic. Int J Phonosurg Laryngol 1:29–31. CrossRefGoogle Scholar
  26. 26.
    Doloi PK, Khanna SA (2011) Study of management of benign lesions of larynx. Int J Phonosurg Laryngol 1(2):61–64CrossRefGoogle Scholar
  27. 27.
    Phaniendra Kumar V, Srinivasa Murthy M, Ravikanth S, Kumar R (2003) Phonomicrosurgery for benign vocal fold lesions—our experience. Indian J Otolaryngol Head Neck Surg 55(3):184–186. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of ENTMGM and MY HospitalIndoreIndia

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