European Journal of Cardiovascular Medicine

Hoarseness of voice is one of the most common presenting symptoms in otolaryngology and may arise from a wide spectrum of underlying laryngeal pathologies. The causes range from benign, reversible conditions such as vocal cord nodules, polyps, and chronic laryngitis, to potentially life-threatening malignancies, particularly squamous cell carcinoma of the larynx [1,2]. Persistent hoarseness beyond two weeks is widely regarded as a red-flag symptom requiring thorough evaluation to rule out malignancy.

Globally, laryngeal carcinoma constitutes nearly one-third of head and neck cancers, with squamous cell carcinoma being the predominant histological subtype [3]. In India, the burden remains high due to widespread tobacco and alcohol consumption, both of which are established risk factors [2]. In contrast, benign lesions are frequently associated with voice abuse, smoking, infections, and laryngopharyngeal reflux [4]. The diagnostic challenge arises from the clinical overlap in symptomatology, where both benign and malignant lesions initially manifest with hoarseness.

Early detection is critical, as the prognosis of laryngeal malignancies is strongly stage-dependent. Glottic cancers, for instance, have excellent survival outcomes when diagnosed at an early stage [5]. Diagnostic modalities such as indirect laryngoscopy, videolaryngoscopy, microlaryngoscopy, and histopathological confirmation remain indispensable for accurate characterization of lesions.

Although numerous studies have examined laryngeal lesions in patients presenting with hoarseness, regional variations in prevalence, risk factors, and pathological profiles underscore the need for continued investigation [1,2,4]. Identifying the spectrum of benign and malignant lesions in specific populations not only enhances diagnostic accuracy but also assists clinicians in adopting timely management strategies and improving patient outcomes.

The present study was undertaken to analyze the spectrum of benign and malignant laryngeal lesions in patients presenting with hoarseness of voice, with emphasis on demographic distribution, anatomical sites involved, and clinical manifestations.

Study Design and Setting

This was a cross-sectional observational study conducted in the Department of E.N.T, Government Medical College and Government General Hospital, Rajanna Siricilla, Telangana. The study was carried out over a period of nine months, from November 2024 to July 2025.

Study Population

A total of 100 patients of varying age groups and both genders, presenting with hoarseness of voice to the outpatient and inpatient departments, were enrolled in the study. Written informed consent was obtained from all participants prior to inclusion.

Inclusion Criteria

Patients presenting with hoarseness of voice persisting for more than two weeks.

Patients willing to undergo diagnostic evaluation and provide consent for participation.

Exclusion Criteria

Patients with transient hoarseness associated with acute upper respiratory tract infections.

Patients previously treated for laryngeal malignancy or presenting with recurrent disease.

Patients with systemic neurological or endocrinological disorders known to affect vocal function.

Data Collection and Clinical Evaluation

All participants underwent comprehensive clinical evaluation. Demographic details, occupational history, addiction profile (tobacco, smoking, alcohol), and duration of symptoms were recorded. General and systemic examinations were performed, followed by focused otolaryngological assessment.

Diagnostic evaluation included:

Indirect laryngoscopy and videolaryngoscopy for initial visualization of laryngeal structures and documentation of lesions.

Microlaryngoscopy under general anesthesia, where required, to enable detailed evaluation, excision of benign lesions, and procurement of biopsy samples.

Histopathological examination (HPE) of tissue specimens, which served as the confirmatory diagnostic tool for distinguishing benign from malignant lesions.

Outcome Measures

The primary outcome was to determine the spectrum of benign and malignant laryngeal lesions in patients presenting with hoarseness of voice.

The secondary outcomes included evaluation of anatomical site distribution of malignant lesions and characterization of associated clinical manifestations.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistical methods were applied, and findings were expressed as frequencies, proportions, and percentages for categorical variables.

Ethical Considerations

Ethical approval for the study was obtained from the Institutional Ethics Committee of Government Medical College and Government General Hospital, Rajanna Siricilla, Telangana. Confidentiality was maintained, and all procedures adhered to ethical research standards.

A total of 100 patients presenting with hoarseness of voice were included in the study. The demographic profile is summarized in Table 1. The majority of patients were between 41–60 years (46%), followed by 21–40 years (32%). Only 10% were ≤20 years, and 12% were above 60 years. Males constituted 62% of the cohort, while females accounted for 38%, with an overall male-to-female ratio of 1.6:1.

Table 1. Demographic Profile of Patients (n = 100)

The distribution of laryngeal lesions is presented in Table 2. Benign lesions (68%) predominated over malignant lesions (32%). Among benign lesions, vocal cord polyps (24%) and nodules (18%) were the most frequent, followed by chronic laryngitis (12%), Reinke’s edema (7%), granuloma (4%), and papilloma (3%). Squamous cell carcinoma represented the major malignant pathology (28%), while verrucous carcinoma and adenocarcinoma each accounted for 2% of cases.

Table 2. Spectrum of Laryngeal Lesions in Patients with Hoarseness (n = 100)

Figure 1: Spectrum of Laryngeal Lesions in Patients with Hoarseness (n = 100)

The anatomical distribution of malignant lesions is detailed in Table 3. The glottis was the most common site of involvement (56.3%), followed by the supraglottic region (28.1%). Subglottic (9.4%) and transglottic (6.2%) lesions were relatively less frequent.

Table 3. Distribution of Malignant Lesions by Site (n = 32)

Figure 2. Distribution of Malignant Lesions by Site

Clinical manifestations are summarized in Table 4. All patients presented with hoarseness of voice (100%). Throat discomfort was reported in 38% of patients, while dysphagia and odynophagia were observed in 22% and 16% of cases, respectively. Dyspnea was noted in 8% of patients, typically in those with advanced malignant lesions.

Table 4. Clinical Presentation of Patients with Hoarseness (n = 100)

Hoarseness of voice remains one of the most frequent clinical presentations in otolaryngology, and its etiological spectrum ranges from benign phonatory disorders to malignant laryngeal neoplasms. In the present study from a tertiary care center in Telangana, benign lesions were more commonly observed (68%) than malignant lesions (32%). This pattern is consistent with other Indian series where benign pathologies such as polyps, nodules, and chronic laryngitis predominated among patients presenting with hoarseness [6,7].

The age distribution in our cohort showed peak prevalence in the 41–60 year group (46%), followed by 21–40 years (32%). Comparable findings have been documented in recent Indian studies, where midlife individuals were most affected, reflecting the cumulative impact of tobacco and alcohol use, occupational voice abuse, and reflux-related irritation [8]. Male preponderance with a male-to-female ratio of 1.6:1 in our study mirrors earlier reports, where higher exposure of men to environmental and lifestyle risk factors contributed to this disparity [9].

Among benign lesions, vocal cord polyps (24%) and nodules (18%) were most frequent, with Reinke’s edema, granulomas, and papillomas contributing a smaller proportion. Similar patterns have been reported by Malik et al. and Sheth et al., where benign vocal fold lesions linked to phonotrauma, infections, and laryngopharyngeal reflux accounted for nearly two-thirds of cases [8,9]. Rare benign conditions, including unusual entities like laryngeal Castleman disease, though uncommon, have also been described in the literature, emphasizing the diverse pathology that can underlie hoarseness [6].

Malignancies constituted one-third of cases, with squamous cell carcinoma (SCC) being the predominant histological subtype (28%). This finding is in accordance with previous Indian studies, where SCC consistently emerged as the most frequent laryngeal malignancy due to its strong correlation with smoking, alcohol consumption, and poor vocal hygiene [7,10]. The anatomical distribution of malignant lesions in our cohort showed glottic involvement as most common (56.3%), followed by supraglottic disease (28.1%). Similar site distribution has been highlighted in studies by Soni and Chouksey as well as Sheth et al., where early onset of hoarseness led to earlier diagnosis of glottic tumors, whereas supraglottic lesions often presented late with advanced symptoms [9,11].

Although SCC dominates the malignant spectrum, non-squamous pathologies, including verrucous carcinoma, adenocarcinoma, and rare variants, have also been recognized in laryngeal oncology. Dogan et al. emphasized that these entities, although less frequent, demand careful imaging and histopathological evaluation due to their overlapping clinical presentations [12].

Clinically, hoarseness was universal in our cohort, with associated symptoms such as throat discomfort, dysphagia, odynophagia, and dyspnea. These manifestations reflect the natural history of laryngeal lesions, where benign conditions largely cause phonatory disturbances, while malignant processes may produce progressive airway compromise or infiltrative symptoms [10].

Overall, our findings underscore the importance of early laryngoscopic assessment and histopathological confirmation in all patients with persistent hoarseness. While benign lesions can often be managed with conservative or minimally invasive measures, early recognition of malignant disease—particularly glottic cancers—offers an excellent prognosis with organ-preserving therapeutic strategies [7,11].

Limitations

Being a single-center, hospital-based study, the results may not be generalizable to the community. The relatively small sample size and short study duration also restrict broader epidemiological inferences. However, the study adds valuable regional data to the existing literature and underscores the need for multicentric research with larger cohorts.

Hoarseness of voice is a significant clinical symptom warranting thorough evaluation, as it encompasses a wide spectrum of laryngeal lesions ranging from benign to malignant. In this study, benign lesions such as vocal cord polyps and nodules predominated, while squamous cell carcinoma was the leading malignant pathology. The glottis emerged as the most frequently affected site in malignancies. Male preponderance and peak incidence in middle age reflect the influence of lifestyle and occupational risk factors. Early laryngoscopic assessment and histopathological confirmation remain essential for accurate diagnosis. Prompt recognition and intervention can improve voice outcomes, facilitate organ preservation, and enhance overall prognosis.

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