Laryngeal Allergic Mucoid Impaction in Bilateral False Vocal Cords

Abstract

Mucoid impaction is a well-known source of bronchial and bronchiolar obstruction, particularly in patients with bronchial asthma. It is a clinical syndrome characterized by inspissated mucus occluding a narrowed segmental bronchus. If the impacted mucous is not removed by natural defensive mechanisms, dilation and atrophy of the bronchus occur, followed by pneumonitis, bronchiectasis, and formation of abscess. Clinical and radiographic differential diagnosis may include bronchogenic carcinoma and pulmonary tuberculosis, thereby necessitating accurate diagnosis. We report the first case of laryngeal mucoid impaction in bilateral false vocal cords in a patient with bronchial asthma. The patient is a 57-year-old female with bronchial asthma and allergic fungal sinusitis who presented with progressive dysphonia in 2015 and was found to have a left false vocal cord mass. The mass was biopsied at our institution, revealing dense chronic inflammation rich in eosinophils, admixed allergic mucin, and negative for fungal infection. She returned recently complaining of increasingly strained and fluctuating hoarse voice. A computed tomography of the neck demonstrated a potentially concerning lesion of the right false vocal cord without lymphadenopathy. She underwent suspension micro-laryngoscopy (SML) with right false vocal cord cystic mass marsupialization. Intraoperatively, the mass was remarkable for multiple submucosal small cysts filled with thick mucin. Microscopic examination of the lesion revealed a chronically inflamed respiratory mucosa with mucoid impaction associated with allergic mucin and negative for malignancy. Grocott's methenamine silver stain (GMS) was negative along with a negative fungal culture, confirming the diagnosis of an allergic mucoid impaction. In conclusion, to the best of our knowledge, we report the first case of laryngeal allergic mucoid impaction in bilateral false vocal cords per current literature review.