Bilateral vocal fold polyps.A 48-year-old woman--a hospice office manager and soprano in her church choir--had a 6-month history of slowly progressive hoarseness, vocal fatigue, loss of range, and a sensation of "not getting enough air." Her vocal troubles began alter an episode of laryngitis. Her medical history included allergic rhinitis, which was treated with an antihistamine antihistamine (ăn'tĭhĭs`təmēn), any one of a group of compounds having various chemical structures and characterized by the ability to antagonize the effects of histamine. and nasal steroid spray, and sarcoidosis Sarcoidosis Definition Sarcoidosis is a disease which can affect many organs within the body. It causes the development of granulomas. Granulomas are masses resembling little tumors. They are made up of clumps of cells from the immune system. , which required no treatment. Laryngeal examination demonstrated a large left polyp and a smaller right mass (figure), in addition to laryngo-pharyngeal reflux. On stroboscopy, the vocal fold masses displayed scalloped stiffness at their bases that extended anteriorly and posteriorly away from the masses. The masses prevented adequate glottal glot·tal adj. Of or relating to the glottis. glottal (glot´ closure, which led to significant glottal air escape. Laryngeal electromyography demonstrated mild paresis of the right superior laryngeal nerve superior laryngeal nerve n. A branch of the vagus nerve at the inferior ganglion. At the thyroid cartilage, it divides into two branches, the internal, which supplies the mucous membrane of the larynx above the vocal cords; and the external, which . [FIGURE OMITTED] The patient's reflux was treated with a twice-daily proton-pump inhibitor and a nightly [H.sub.2] blocker. Speech therapy did not result in any adequate vocal improvement, and the patient underwent microdirect laryngoscopy with bilateral mass excision and dexamethasone injections. Her hoarseness and vocal fatigue resolved, and her pitch range improved. Libby J. Smith, DO; Robert T. Sataloff, MD, DMA From the Department of Otolaryngology. University of Pittsburgh Medical Center The University of Pittsburgh Medical Center (UPMC) is a leading American healthcare provider and institution for medical research. It consistently ranks in US News and World Report's "Honor Roll" of the approximately 15 best hospitals in America. (Dr. Smith), and the Department of Otolaryngology Head and Neck Surgery, Drexel University College of Medicine Drexel University College of Medicine is the medical school of Drexel University. It represents the consolidation of two venerable medical schools: the nation's first medical school for women and the first U.S. college of homeopathy. Residency Locations St. , and Graduate Hospital. Philadelphia (Dr. Sataloff). |
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