A vocal fold polyp is a benign lesion related to phonotrauma which induces upregulation of inflammatory processes and histological changes can occur in the epithelium and lamina propria. Whether smoking produces additional or enhanced changes is the subject of this study. Twenty-nine patients presenting with vocal fold polyps were divided into smoking and non-smoking groups and various parameters, ranging from duration of hoarseness to histopathological features were compared with statistical analysis. It was observed that smokers presented much later than non smokers, presuming it was just laryngitis. The mean polyp size was larger in smokers. Smokers had more keratinising features. Atypia was not seen in non-smokers but 35% of smokers showed this change. Cigarette smoking was associated with higher rate of laryngopharyngeal reflux. Smokers also had thinner basement membrane which has been explained by upregulation of inflammatory process producing more malleoproteinases which may promote membrane digestion and dissolution. This is an important step in progression from carcinoma in situ to microinvasive carcinoma. Hyaline generation was greater in smokers. All these results were statistically significant. The study confirms superadded injurious effects of smoking on vocal fold polyp that is already altered by phonotrauma and offers enhanced caution on smoking.

A comparative histopathological study of vocal fold polyps in smokers versus non-smokers.
Effat KG, Milad M.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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