In brief
Hoarseness lasting more than 3–4 weeks should be assessed with endoscopy of the larynx.
Smokers should not delay a check-up: laryngeal cancer, when detected early, can in most cases be cured while preserving the voice.
The larynx protects the airway during swallowing, allows breathing and produces the voice through the vibration of the vocal folds.
It is divided into three regions: supraglottis, glottis (the vocal folds) and subglottis.
The consultation
The larynx is examined with a rigid endoscope (70° and 90° optics) or a flexible endoscope, and with videolaryngostroboscopy, which shows the vibration of the vocal folds in slow motion.
The examination is available at all the venues where Dr Dehgani-Mobaraki sees patients and is performed in the clinic, without general anaesthesia.
Benign vocal fold lesions
- Nodules: bilateral, related to incorrect or excessive use of the voice; treated first with voice therapy.
- Polyps: usually one-sided, often after vocal strain; persistent polyps are removed with laryngeal microsurgery.
- Cysts: within the vocal fold, they generally require microsurgery.
- Reinke’s oedema: swelling of the vocal folds typical of smokers, with a deep voice; treated by stopping smoking and, if needed, microsurgery.
- Granulomas: often related to reflux or intubation.
- Papillomatosis: caused by HPV, it tends to recur and requires repeated removal.
Voice therapy is part of the treatment, before and after any surgery.
Leukoplakia and precancerous lesions
Leukoplakia is a whitish patch on the vocal fold.
It may correspond to simple thickening, to dysplasia of varying grade or to early carcinoma: for this reason it must be removed or biopsied and examined.
Vocal fold paralysis
One-sided paralysis causes a weak, breathy voice and sometimes coughing when drinking.
The most common causes are thyroid, neck or chest surgery, lung and mediastinal disease, or forms with no evident cause.
Management includes looking for the cause with a CT scan from the skull base to the mediastinum, voice therapy and, if the voice does not improve, medialisation of the vocal fold.
Laryngeal cancer
Squamous cell carcinoma of the larynx is linked mainly to smoking, with the effect amplified by alcohol.
Vocal fold tumours cause hoarseness early and are often diagnosed at an early stage; supraglottic tumours may cause sore throat, ear pain, difficulty swallowing or a lump in the neck.
- Early stages: transoral endoscopic laser surgery or radiotherapy, with good chances of cure and preservation of the voice.
- Intermediate stages: partial laryngeal surgery or organ-preservation protocols with chemoradiotherapy.
- Advanced stages: total laryngectomy with voice rehabilitation (voice prosthesis), usually followed by radiotherapy.
Every case is discussed by the multidisciplinary team with the radiation oncologist and the medical oncologist.
Further reading: TNM staging calculator and treatment options (in Italian).
Author: Dr Puya Dehgani-Mobaraki. Last reviewed: October 2026.