Hemorrhagic polyp with a contralateral contact lesion.A 35-year-old trial lawyer came to our office complaining of vocal fatigue and raspiness. The man said that the vocal fatigue had been bothersome for many years. His voice was mildly raspy. Three months earlier, he had experienced an acute voice change while screaming at a football game. His voice had not recovered, and his hoarseness was severely compromising his ability to work. His medical history was otherwise unremarkable except for a tonsillectomy tonsillectomy /ton·sil·lec·to·my/ (ton?si-lek´tah-me) excision of a tonsil. ton·sil·lec·to·my n. Surgical removal of tonsils or a tonsil. and rhinoplasty Rhinoplasty Definition The term rhinoplasty means "nose molding" or "nose forming." It refers to a procedure in plastic surgery in which the structure of the nose is changed. more than 10 years earlier. He did not smoke, and he drank alcohol only socially. Stroboscopic examination of the larynx demonstrated a vascular bleb bleb (bleb) a large flaccid vesicle, usually at least 1 cm. in diameter. bleb n. A large flaccid vesicle. bleb a large flaccid vesicle, usually at least 0. on the right vocal fold and a contact lesion on the left vocal fold (figure 1). There was also evidence of a 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 paresis paresis /pa·re·sis/ (pah-re´sis) slight or incomplete paralysis. general paresis paralytic dementia; a form of neurosyphilis in which chronic meningoencephalitis causes gradual loss of cortical and laryngopharyngeal reflux. Laryngeal electromyography demonstrated a 30% reduction in recruitment in the right cricothyroid muscle, a finding that was consistent with a right superior laryngeal nerve paresis. Serologic and radiologic studies were negative. The patient was started on voice therapy, placed on intensive medical therapy for reflux, and asked to return in approximately 6 weeks for a follow-up evaluation. [FIGURE 1 OMITTED] The patient returned 2 weeks early with another acute voice change. Examination revealed that the vascular bleb had progressed to a hemorrhagic polyp. The patient elected to proceed with surgical excision. Intraoperative evaluation with a 0 [degrees] laryngeal telescope confirmed the nature of the right posthemorrhagic polyp (figure 2). Palpation palpation /pal·pa·tion/ (pal-pa´shun) the act of feeling with the hand; the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis. revealed that the left contact mass was hard. Evaluation with a 70 [degrees] laryngeal telescope demonstrated that the base of the polyp was broad (figure 3). Both masses were excised. The patient was placed on 1 week of absolute voice rest followed by 5 weeks of restricted voice use. He did well, and eventually returned to work at full capacity. [FIGURES 2-3 OMITTED] From the Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University It began as Jefferson Medical College in 1824. On July 1, 1969 the institution officially became Thomas Jefferson University. The university is made up of three colleges:
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