Hemorrhagic polyp following intubation.

A 40-year-old motivational speaker presented to our office with a 3-month history of dysphonia. His symptoms had begun immediately after he had undergone a 5-hour urologic procedure performed with general anesthesia. He had had no vocal complaints prior to surgery, he had no other significant medical history, and he did not smoke. A local otolaryngologist who evaluated him initially had reached a diagnosis of postintubation granuloma. The patient was placed on a twice-daily proton-pump inhibitor and a once-nightly [H.sub.2] antagonist. When his mass did not resolve and his symptoms persisted, he was referred to us.

Stroboscopic examination of the larynx detected a large hemorrhagic polyp and stiffness of the fight vocal fold. The right vocal fold also had a yellowish hue consistent with a resolving hematoma. There was evidence of moderate laryngopharyngeal reflux. Findings on laryngeal electromyography were normal. Surgery was recommended, and the patient was started on preoperative voice therapy.

Intraoperative evaluation with a 0[degrees] laryngeal telescope confirmed the nature of the mass (figure, A). Evaluation with a 70[degrees] laryngeal telescope demonstrated that the base of the polyp was narrow except at its anterior aspect (figure, B). The patient underwent microdirect laryngoscopy with excision of the right vocal fold polyp. He did well postoperatively and returned to professional voice use.

[FIGURES A-B OMITTED]