Epiglottic cartilage calcification: a retrospective study based on computed tomography of a clinical and histological paradox

The epiglottis is a leaf-shaped elastic cartilage structure that guides air into the larynx and prevents food entry into the respiratory tract. Unlike other laryngeal cartilages, it rarely calcifies. Epiglottic calcification is poorly understood, with most data from case reports or postmortem studies, and its prevalence in living individuals remains unclear. This study aims to assess epiglottic calcification on neck computed tomography (CT) and explore associations with age, sex, and medical history. This retrospective observational study evaluated 203 high-resolution neck CT scans from adult patients between 2023 and 2025. Patients with structural abnormalities, prior neck surgery, or poor-quality scans were excluded. Calcification was assessed on the base, body, and stalk of the epiglottis by anatomical location on the epiglottic wall (anterior, posterior, or full thickness) and severity of the lesion (mild, moderate, severe). Two experienced observers independently reviewed all scans, resolving discrepancies by consensus. Only 5 out of 203 patients (2.46%) showed epiglottic calcification, all males aged over 60. Calcifications were primarily located in the body and base, with no involvement of the stalk and no severe or full-thickness cases. No associated epiglottic deformities were observed. Epiglottic calcification is predominantly affecting elderly males. The absence of symptoms suggests a benign, age-related change rather than a pathological condition. Recognition on CT is essential to prevent unnecessary procedures. Further studies integrating imaging, histology, and clinical data are needed to better understand its pathophysiology, and potential clinical implications.