Hemorrhage, varicosity, and cysts in a professional singer.

A 46-year-old woman, a pop singer, complained of hoarseness, difficulty singing in her high range, neck pain after singing, difficulty projecting, and vocal fatigue. She had experienced vocal fold hemorrhages with acute voice changes on three previous occasions--6 months, 1 year, and 4 years prior to our examination. Her medical history was significant for a clothesline injury with loss of consciousness as a child, an undifferentiated connective tissue disorder, temporomandibular joint disease, laryngopharyngeal reflux, and allergic rhinitis. Her medications included esomeprazole 40 mg three times daily, ranitidine 300 mg at bedtime, and occasional vitamins. She had previously taken immunotherapy for allergies. Her previous surgeries included a tonsillectomy, adenoidectomy, and "vocal fold vein surgery" at the age of 16 years.

Strobovideolaryngoscopy revealed a large left varicosity, a firm left vocal fold mass, and a right vocal fold cyst with a smaller varicosity. The patient was scheduled to undergo a left varicosity excision, bilateral mass excisions, and bilateral dexamethasone injections. The week prior to surgery, her left varicosity hemorrhaged into the vocal fold and mass, and she was placed on absolute voice rest until surgery.

Surgery was performed as planned. Intraoperative telescopic views of the vocal folds demonstrated a left vocal fold varicosity, an old left hemorrhage, a left hemorrhagic cyst, a right vocal fold cyst (figure, A), and the raised nature of the varicosity (figure, B). She was placed on absolute voice rest for 1 week after surgery, after which time she resumed voice therapy.

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Libby J. Smith, DO; Robert T. Sataloff, MD, DMA

From the Department of Otolaryngology, University of Pittsburgh Medical Center (Dr. Smith), and the Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine and Graduate Hospital, Philadelphia (Dr. Sataloff).