Pictures of Intubation Granuloma of the Larynx

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Picture of intubation granuloma of the larynx.

Picture of bilateral intubation granuloma of the larynx

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Pictures of Foreign Body in the Larynx and
Trachea
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Picture of Subglottic Laryngeal Granuloma

and Tracheal Stenosis

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This patient was endotracheally intubated for several weeks, before a tracheostomy was performed. A
subglottic intubation granuloma was found when she was unable to speak with a Passy-Muir speaking
valve.
When the granuloma was excised, a band of scar tissue partially covering the tracheotomy tube( the blue
structure) was discovered.

The tracheotomy tube was replaced with a laser resistant tube and the band of scar tissue was vaporized
with the CO2 laser. For pictures of tracheal resection and end-to-end anastomosis,
click here:
Tracheal Resection and end-to-end Anastomosis
Pictures of Total Subglottic and Upper Tracheal Stenosis
This patient has a total occlusion of the subglottic region. The whitish material is food stuck in the
subglottis.

Following prolonged intubation, this patient developed severe scarring and near-total occlusion of the
subglottic region.
Total subglottic stenosis and occlusion (same patient as in picture above, after removal of food debris).

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Following prolonged intubation, this patient developed severe scarring and near-total occlusion of the
subglottic region.

For pictures of tracheal resection and end-to-end anastomosis, click here:

Tracheal Resection and end-to-end Anastomosis
This patient has a total occlusion of the subglottic region. The whitish material is food stuck in the
subglottis.
Total subglottic stenosis and occlusion (same patient as in picture above, after removal of food debris).

Otolaryngology Houston
Bechara Y. Ghorayeb, MD
8830 Long Point, Suite 806
Houston, Texas 77055
For appointments, call 713 464 2614
Suspension Microlaryngoscopy Picture of Foreign Body in the Larynx

Five years ago, this patient had a tracheotomy and was decannulated six
months later. His tracheostoma healed well. He presented with a history of
intractable cough that did not respond to any treatment. On flexible
fiberoptic laryngoscopy, he had a bluish string originating in the trachea and
emerging between the vocal cords. The string looked like a Prolene suture
with a surgical knot (see pictures below).

Suspension Microlaryngoscopy Picture of Foreign Body in the Larynx

A suspension microlaryngoscopy confirmed that this was a Prolene surgical

suture. When the suture was grasped with a foreign body forceps and
pulled, it was evident that it was a loop that originated in the tracheotomy
scar. Every time the string was pulled, it pulled the tracheostomy scar into
the trachea. Finally, the loop was cut with micro-laryngeal scissors and
pulled out. The original surgeon must have placed this suture in a
tracheotomy "trapdoor flap" to be used as a drawstring when changing
tubes. Then this suture must have been completely pushed inside the
tracheal lumen and never removed on decannulation.
Prolene suture with surgical knot, removed from the trachea and
larynx.

Laryngeal Photos: Trauma

An intubation trama temporarily fixed the right arytenoid from swelling.

After an intubation that saved his life, this patient developed trouble breathing weeks later.He had a tracheostomy placed and was told to wait a
paralyzed and they might start moving again. See diagnosis and another discussion about bilateral paralysis. Paralysis usually starts out with the

Granuloma

Granulomas are typically

located over the vocal
process of the arytenoid
cartilage. They may be
caused from intubations
 during anesthesia or from
vocal trauma (typically
speaking at too low a
pitch). Click on the photo
to see a range of types of
granulomas.

Laryngopharyngeal - Gastroesophageal Reflux Disease

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Intubation Granuloma
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Intubation Granuloma Video (Windows Media Video .wmv)
Intubation Granuloma Video (Flash Video .swf)
Contact Ulcers

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Granuloma

Also called contact ulcers, granulomas are discrete (clearly-defined) lesions that occur on the
back portion of the vocal fold where it attaches to the arytenoid cartilage. Laryngopharyngeal
reflux (LPR) is the most common cause of formation of a granuloma. Another common cause is
irritation from an endotracheal tube (the tube placed in the throat for breathing during a surgery
under general anesthesia), which can rub against the back of the larynx.

Treatment for granuloma depends upon the size of the lesion and the length of time it has been
present, but most likely will require control of reflux, and may also include relative voice rest,
and/or surgery and voice therapy. Surgery by itself, without other measures, will often result in
the regrowth of the lesion in a short period of time.
 GRANULOMA - The vocal fold on the right side of the picture has a granuloma attached to
the vocal process

(top of picture).

GRANULOMA - The posterior vocal process on the left side of this picture has a large
granuloma, which causes painful phonation and swallowing for this patient.
 GRANULOMA - The granuloma seen on the left side of this photo is causing a small reactive e oppos
lesion on th

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Laryngopharyngeal Reflux Disease (LPR)

Acid reflux may be a primary cause of or a contributing factor to voice problems. Many people have heard
When the refluxing of stomach acid primarily affects the esophagus, it is termed gastroesophageal reflux
the refluxing affects primarily the voice production system the larynx and pharynx it is called laryngop
(LPR). It may also be called reflux laryngitis.

When normal, healthy individuals eat or drink, swallowing propels food and liquid from the back of the mo
esophagus, the tube connecting the mouth to the stomach. Two esophageal sphincters, or valves, open a
to promote passage of food into the stomach and prevent backflow.

GERD, or classic reflux, occurs when the acid contents move from the stomach backwards up the esoph
improper functioning of one or both sphincters (which can be aggravated by a condition known as hiatal
muscular spasms of the esophagus.

LPR occurs when refluxed stomach contents reach all the way up into the throat. Almost everyone experie
When acid reflux occurs often, however, the larynx can become irritated, because the larynx and back of
same type of lining as the esophagus to protect from acidic fluids. Sometimes, if the LPR is severe enoug
cancerous lesion (growth) on the back of the vocal fold, called a granuloma.
Symptoms of LPR can include: a choking sensation, sometimes severe enough to wake a person up at nig
changes; a sensation of something caught in the throat; frequent coughing and throat clearing; and a sou
mouth, especially upon rising in the morning. The classic symptoms of heartburn, burping or chest pres
GERD, but not necessarily with LPR.

Many patients with voice problems caused by LPR are not even aware that they have acid reflux problem
bothersome symptoms of LPR, this condition can create habits which further contribute to the voice probl
throat-clearing or using excessive muscle tension when speaking.

LPR is treated primarily in two ways. Making some simple lifestyle, or behavioral changes can help preve
improve the voice. Take a look at our LPR Precautions Tips (PDF) for some helpful suggestions. In conjunctio
medications can also be used to help control LPR. Behavioral changes should always accompany medicat
medication work most effectively. In many instances, it can take a few months of regular medication use
are significantly reduced.

There are many medications, some over-the-counter and some requiring a prescription. The amount of m
time of day it is used, can significantly influence its effectiveness. If you think you have reflux laryngitis, s
(ear, nose and throat physician) who is experienced in treating voice disorders.

LARYNGOPHARYNGEAL REFLUX: LPR has caused inflammation (redness and swelling) of

the back of the larynx. The vocal fold mucosa is irritated and copious thick secretions cover the
vocal folds. This causes discomfort and irregular mucosal wave vibration, leading to voice
changes.
Right sided Granuloma from acid reflux disease

Acid reflux

MRI, head and neck, sagittal section

This is an example of a patient who has acid reflux into the larynx (laryngopharyngeal
reflux disease, or LPRD). The larynx is red and swollen. This patient also has
leukoplakia, which is a premalignant white growth on the vocal folds. The picture on
the left is the first examination, and the picture on the right was taken after just six
weeks of medical treatment for LPRD. Notice that the changes on the vocal folds have
been reversed, and the redness has subsided dramatically.
Initial videostroboscopy revealed untreated LPR Status post six month course of proton pump inhibitor
Subglottic web formation secondary to acute,
severe laryngopharyngeal reflux.
Pictures of Chronic Laryngitis and Leukoplakia
This page was last updated: February 27, 2007
Pictures

Hemorrhagic Vocal Nodule

Laryngeal Lesions, Benign

Laryngeal Polyps and Cancers

Laryngeal Hyperkeratosis

Laryngoscopy, Suspension Microlaryngoscopy

Laryngeal Injection / Injection of Vocal Cords

Laryngeal Candidiasis (Moniliasis)

Intubation Granuloma

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Chronic Laryngitis
This patient smoked 80 cigarettes daily. The vocal cords are swollen and covered with plaques of whitish
keratinized mucosa (leukoplakia). Leukoplakia is related to smoking and is precancerous.
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Leukoplakia
This is the larynx of a chronic smoker who presented with hoarseness. The whitish discoloration of the
laryngeal mucosa is noted over the true vocal cords and posteriorly over the arytenoids and inter-
arytenoid region.
For pictures of laryngeal cancer, click here.
Otolaryngology Houston
Bechara Y. Ghorayeb, MD
8830 Long Point, Suite 806
Houston, Texas 77055
For appointments, call 713 464 2614
Leukoplakia
This patient is also a chronic smoker who presented with hoarseness and cough. There is a large white
plaque on the right vocal cord.