Progressive Hoarseness and Laryngeal Obstruction in an Elderly Man

An otherwise healthy man in his 60s presented to a tertiary otolaryngology clinic reporting a 1-year medical history of progressively worsening hoarseness and dyspnea. He denied any history of dysphagia, odynophagia, fevers, unintentional weight loss, cough, or reflux symptoms. There was no prior history of smoking, head and neck surgeries, or radiation exposure. He was treated for asthma with inhaled steroids by his primary care physician without improvement in symptoms. On physical examination, the patient was stridulous and considerably hoarse. His neck examination was unremarkable. Subsequent videostroboscopy revealed severe laryngeal mucosal edema, most significant in the false vocal folds, interarytenoid, and postcricoid regions (Figure 1A). There was right true vocal fold immobility with compensatory squeeze of the false vocal folds and an absent mucosal wave. Computed tomographic (CT) scan of the neck with contrast showed irregularity along the free edges of the true vocal folds but no evidence of a neoplasm or cervical lymphadenopathy. The patient underwent urgent direct laryngoscopy with biopsy, which showed edematous, irregular, friable laryngeal mucosa with significant airway narrowing. Laryngeal biopsy findings are shown in Figure 1, B and C.