Our Summary

Gout nodules, also known as tophi, are deposits of urate crystals that form due to long-term inflammation. They typically appear in and around joints, under the skin, in the ear, and in the kidney, and are a common sign of gout. However, vocal cord tophi are quite rare and not often reported. When they do occur, they can cause symptoms such as a hoarse voice and difficulty swallowing. This paper discusses a case where a vocal cord mass was discovered in a patient who had gout for over 20 years. The mass was found to be a tophus. Tophi can lead to serious problems, so they should be considered when diagnosing laryngeal masses in patients with a history of gout. Treatment should involve reducing uric acid levels in the body and surgery to alleviate symptoms and prevent the tophi from recurring.

FAQs

  1. What are gout nodules or tophi and where can they appear in the body?
  2. How are vocal cord tophi treated?
  3. What symptoms can vocal cord tophi cause?

Doctor’s Tip

A doctor may tell a patient undergoing vocal cord surgery to follow post-operative care instructions carefully, including avoiding smoking and excessive voice use to allow the vocal cords to heal properly. It is also important to attend all follow-up appointments and voice therapy sessions to ensure a successful recovery and optimal vocal function.

Suitable For

Patients who are typically recommended vocal cord surgery include those with vocal cord nodules, polyps, cysts, or tumors that are causing significant voice problems or difficulty swallowing. Patients with vocal cord paralysis or other structural abnormalities that affect vocal cord function may also be candidates for surgery. Additionally, patients with chronic inflammation or scarring of the vocal cords, such as from long-term acid reflux or smoking, may benefit from surgical intervention to improve vocal cord function. Overall, vocal cord surgery is recommended for patients who have tried conservative treatments such as speech therapy or medication and have not seen improvement in their voice or swallowing issues.

Timeline

  • Before surgery:
  1. Patient experiences symptoms such as hoarse voice and difficulty swallowing.
  2. Patient is diagnosed with a vocal cord mass, which is later identified as a tophus.
  3. Patient’s medical history reveals a long-term history of gout.
  • After surgery:
  1. Surgery is performed to remove the vocal cord tophus.
  2. Patient undergoes treatment to reduce uric acid levels in the body.
  3. Symptoms improve and the patient’s voice and swallowing function may return to normal.
  4. Follow-up care is provided to monitor for recurrence of tophi and to manage gout effectively.

What to Ask Your Doctor

  1. What is the specific diagnosis for my vocal cord issue?

  2. How common are vocal cord tophi in patients with gout?

  3. What are the potential risks and complications associated with vocal cord surgery?

  4. What are the expected outcomes of the surgery in terms of voice quality and swallowing function?

  5. What is the recommended treatment plan following surgery to prevent recurrence of vocal cord tophi?

  6. How long is the recovery process expected to take, and what can I do to aid in my recovery?

  7. Are there any lifestyle changes or dietary modifications that I should make to help manage my gout and prevent future vocal cord issues?

  8. Are there any alternative treatments or therapies that may be beneficial in conjunction with surgery?

  9. How frequently should I follow up with you after the surgery?

  10. Are there any specific warning signs or symptoms that I should watch out for post-surgery that may indicate a complication?

Reference

Authors: Wang Y, Ma R, Ruan B, Guo M. Journal: Ear Nose Throat J. 2025 Mar;104(1_suppl):287S-290S. doi: 10.1177/01455613221137225. Epub 2022 Nov 24. PMID: 36420695