Step 1: The image shows laryngeal papillomatosis (recurrent respiratory papillomatosis, RRP), the most frequent benign tumour of the larynx.
Step 2: It is caused by human papillomavirus (HPV) types 6 and 11 and is the second most common cause of hoarseness in children.
Step 3: The papillomas sit primarily on the vocal cord margins, anterior commissure and epiglottis, and although benign they cause obstructive symptoms due to their location on the cords.
Step 4: The wart-like, frond appearance distinguishes it from Reinke's edema (smooth polypoid swelling), malignancy (ulceroproliferative mass) and tracheomalacia - so the lesion is laryngeal papilloma.