Acute laryngitis in a professional singer.

A 38-year-old international-class baritone came to us 6 hours before he was scheduled to deliver a major operatic performance in Philadelphia. He said that he had been experiencing mild symptoms of upper respiratory infection for approximately 1 week. Two days prior to our evaluation, his "postnasal drip" and sore throat had worsened, and his voice had started to "thicken" slightly. The patient also had a mild cough, which he attributed to excessive phlegm. Following that evening's performance, he was not scheduled to perform again for another week. The man was in the midst of a successful career. He had studied singing formally for more than 10 years, and he was generally considered to be a technically good singer. He had had no previous voice difficulties of any significance, and he reported only two previous episodes of "laryngitis" during his career. He had been evaluated at another institution 12 hours prior to his visit to us, and he had been started on azithromycin and 32 mg of methylprednisolone.

Strobovideolaryngoscopy revealed acute laryngitis, which was characterized by diffuse erythema and mild edema. There was also a left sulcus vocalis and a small area of stiffness from an old injury in the striking zone on the left vibratory margin (figure). His blood vessels were prominent on the superior surface of both vocal folds, and he had an ectatic vessel on the superior surface of his left vocal fold.

Our evaluation of the patient's singing mechanics revealed excessive tongue tension upon retraction. He was able to correct this problem as soon as it was pointed out to him. With minor performance modifications, he was permitted to sing that evening. His performance was satisfactory, and he recovered without difficulty.