The human voice originates in the larynx, or voice box, which houses the vocal cords. These two small bands of muscle tissue vibrate to produce sound when air passes over them from the lungs. Sometimes, an abnormal change occurs on the surface of these tissues, leading to vocal cord leukoplakia. The term leukoplakia translates from Greek to mean “white patch,” describing its appearance as a white plaque on the vocal cord lining. Although the discovery of an abnormal growth can be alarming, this finding is relatively common and requires medical attention and monitoring.
Defining Vocal Cord Leukoplakia and Its Symptoms
Vocal cord leukoplakia is a clinical description of a thick, white, often irregular patch or plaque visible on the vocal fold surface. This white appearance results from abnormal tissue growth, specifically an excess accumulation of keratin, the protein that makes up hair and skin. Pathologically, this is sometimes called hyperkeratosis. The primary symptom associated with this physical change is persistent hoarseness, medically termed dysphonia.
The presence of the plaque prevents the vocal cord from vibrating smoothly and evenly, leading to a rough or raspy voice quality. The severity of hoarseness often depends on the size and location of the lesion, particularly if it affects the vibrating edge of the cord. Other symptoms include vocal fatigue, where the voice tires easily, or a feeling of a foreign body or lump in the throat.
Primary Causes and Associated Risk Factors
The development of vocal cord leukoplakia is linked to chronic irritation of the laryngeal lining. Exposure to heavy or long-term tobacco use, including smoking and vaping, is the single most significant contributing factor. The irritants in tobacco smoke cause continuous cellular stress, triggering mucosal cells to change and thicken. A history of smoking is also strongly correlated with a higher risk of the lesion developing into cancer.
Another major irritant is chronic laryngopharyngeal reflux (LPR), where stomach acid and enzymes back up into the throat and vocal box, causing a chemical burn. Managing LPR, often through dietary changes and medication, is required for controlling the condition and preventing recurrence. Less commonly, chronic vocal misuse or strain can contribute to the irritation. Certain types of Human Papillomavirus (HPV) have also been noted in association with vocal cord dysplasia in a small number of cases.
The Diagnostic Process and Biopsy
The diagnostic process begins with a detailed history of the patient’s voice changes, followed by a specialized examination. A laryngologist typically performs a laryngoscopy, often using a flexible scope passed through the nose, to visually inspect the vocal cords. To better assess the lesion’s effect on voice function, a video laryngostroboscopy may be used. This procedure employs a flashing light synchronized with vocal fold vibration, helping the clinician evaluate the size, location, and stiffness of the white patch.
While visualization suggests leukoplakia, a definitive diagnosis and assessment of its risk profile require a tissue biopsy. This procedure obtains a sample of the abnormal tissue for analysis by a pathologist. The biopsy is often performed under general anesthesia during microlaryngoscopy. In-office biopsy using specialized lasers or instruments is sometimes an option for smaller, accessible lesions. Pathological review of this sample determines the extent of cellular abnormality and guides subsequent treatment.
Management Approaches and Monitoring Strategies
The approach to managing vocal cord leukoplakia depends on the pathology report and the severity of symptoms. For lesions showing minimal or no cellular abnormality, initial non-surgical management focuses on eliminating the source of irritation. This involves immediate cessation of tobacco use and aggressive treatment of any underlying laryngopharyngeal reflux. Voice therapy may also be introduced to ensure healthy voice use, though it will not remove the lesion itself.
When the lesion is symptomatic, large, or shows concerning cellular changes, surgical removal is often recommended. Techniques include microlaryngeal surgery using delicate instruments to precisely remove the patch while preserving the underlying vocal cord layers. Laser ablation, using tools like the KTP or CO2 laser, is also a common method to destroy or excise the abnormal tissue. The goal of intervention is complete removal with the least possible trauma, maximizing the preservation of long-term voice quality. Because vocal cord leukoplakia has a high rate of recurrence, long-term monitoring is mandatory. Regular follow-up examinations are necessary, even after successful removal, to detect any re-growth or progression early.
Understanding Malignant Potential
The most pressing concern for patients is the potential for the white patch to become cancerous, which is why vocal cord leukoplakia is considered a precancerous condition. The pathologist’s review of the biopsy determines this risk by classifying the extent of cellular abnormality, known as dysplasia. Dysplasia is a spectrum of changes ranging from non-dysplastic lesions (lowest risk) to severe dysplasia or carcinoma in situ (highest risk).
The risk of malignant transformation increases significantly with the severity of the dysplasia found in the tissue sample. While leukoplakia without dysplasia carries a low risk, lesions graded as severe dysplasia or carcinoma in situ have a much higher likelihood of progressing to invasive laryngeal cancer. For example, the transformation rate for mild to moderate dysplasia is approximately 10.6 percent, while severe dysplasia or carcinoma in situ can exceed 30 percent. Adherence to the prescribed follow-up schedule and early detection of progressive changes are the most effective strategies for ensuring a positive long-term outcome.