A 28-year-old man who is a singer/songwriter has been experiencing hard times for the past 3 years. He has played at a couple of clubs a night to earn enough to avoid homelessness. He comes to the free clinic because he has noticed that his voice quality has become progressively hoarser over the past year. On physical examination, he is afebrile. There are no palpable masses in the head and neck area. He does not have a cough or significant sputum production, but he has been advised on previous visits to give up smoking. Which of the following is most likely to produce these findings?

Reactive nodules (vocal cord polyps, or singer's nodules) occur most often in men who are heavy smokers or who strain their vocal cords. The nodules are generally only a few millimeters in size and have a fibrovascular core covered by hyperplastic and hyperkeratotic squamous epithelium. They are not premalignant. Croup is an acute laryngotracheobronchitis that most often occurs in children and produces airway narrowing with inspiratory stridor. Epiglottitis is an acute inflammatory process that may cause airway obstruction. Squamous cell carcinomas of the pharynx and larynx form irregular, ulcerating masses, are more common in smokers, but generally are seen in individuals older than this patient. Squamous papillomatosis usually first appears in childhood; if it is extensive, it can produce airway obstruction.