Laryngeal leukoplakia

What it is

Leukoplakia is a white plaque on a mucous membrane. In the mouth it is a premalignant condition, and presents as white, hard spots on the mucous membranes of the mouth, more common in smokers. In the larynx the same white plaque is seen at laryngoscopy in two conditions:

• Chronic laryngitis, where the cords show hypertrophic epithelium and leukoplakia
• Early laryngeal carcinoma, which on direct laryngoscopy is white (leukoplakic) plaques, while advanced disease is a large exophytic or ulcerative lesion

So a white plaque in the larynx is not itself a diagnosis. It must be biopsied to exclude neoplasia.

Causes and risk

Smoking runs through the whole topic: leukoplakia of the mouth is more common in smokers, and smoking and alcohol are the major risk factors for laryngeal carcinoma. On the cords, leukoplakia is a sign of chronic laryngitis, which is inflammation of the vocal fold mucosa and larynx of a duration the two pages set differently: one puts chronic laryngitis at more than 2 weeks and acute laryngitis at less than 2 weeks, the other puts chronic at more than 3 weeks and acute at less than 3 weeks. Acute laryngitis resolves in about 1 week. The causes of the chronic form:

• GERD, the most common cause
• Recurrent acute laryngitis and recurrent URTI
• Chronic irritants: smoking, chemical fumes, EtOH use
• Chronic voice strain
• Chronic rhinosinusitis with postnasal drip
• Zenker's diverticulum and hiatus hernia
• Hypothyroidism and Addison's disease