Hemorrhagic polyp of the vocal fold.

A 74-year-old man, retired from his own construction business, was referred to us with a 2-month history of hoarseness. He had no previous history of voice problems. He said that the change in his voice began after he had experienced a cold that was accompanied by a persistent cough for a few days. His primary care physician had treated him with antibiotics, but his hoarseness had not resolved.

An otolaryngologic examination with videostroboscopy detected a dorsal hematoma in the midanterior third of the right true vocal fold (figure, A). Sinus drainage and characteristics of laryngopharyngeal reflux (LPR) were also noted. A formal voice evaluation identified patterns of upper chest breathing and voice support difficulties. Results of spirometry were normal, and his phonation quotient was 483 ml/sec. His fundamental frequency (speaking voice) was 124 Hz, and a hard glottal attack and hyperfunction were noted. His pitch range was recorded from G1 at 98 Hz to G3 at 392 Hz and was found to be within normal limits, but with a very hoarse quality. Jitter and shimmer perturbations were outside normal limits. Spectrographic analysis revealed noise at the higher frequencies. Phonetography indicated that the patient's dynamic intensity range fell off at both extremes of F0. His disability index was rated as significant (impairment level 3).

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A trial of conservative treatment with 5 days of methyl-prednisolone and voice rest was prescribed, followed by a series of voice therapy sessions. Voice therapy included identifying and reducing vocal abuse/misuse, counseling regarding dietary changes to reduce LPR and allergy symptoms, practicing proper vocal hygiene, and improving vocal technique with respect to breathing, relaxation, and projection of the speaking voice. The patient was also prescribed modified voice rest during treatment.

While the patient was closely monitored for several weeks, the hematoma became a hemorrhagic polyp (figure, B). After the seventh session of voice therapy during a 1-month period, his voice quality had improved. He followed a regimen of vocal exercises, vocal hygiene, modified voice rest, and dietary changes at home for another month before deciding whether to undergo surgery. Videostroboscopy performed at the completion of the home program revealed that the hemorrhagic polyp had resolved (figure, C). The patient also exhibited a normal voice without hyperfunction. Findings on acoustic analysis were within normal levels, his fundamental frequency was 119 Hz, phonetography showed good dynamic improvement, and his disability index improved to level 6 (minimal impairment). However, the patient's LPR and allergy symptoms persisted, and he was encouraged to continue to make dietary changes, because he had not been following his recommended diet completely.

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A follow-up examination with videostroboscopy 4 months later indicated that all of the patient's vocal deficits had resolved and that his laryngeal anatomy and function were normal (figure, D). No further treatment was necessary.

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From Wayne State University School of Medicine, Detroit (Dr. Jackson-Menaldi), and the Lakeshore Ear, Nose and Throat Center, St. Clair Shores, Mich. (Dr. Jackson-Menaldi, Ms. Knoll, Dr. Fishman, and Dr. Holland).