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.