Hemorrhagic vocal fold polyp and varicosities.

A 53-year-old professional speaker reported a long history of intermittent hoarseness, which was associated with upper respiratory infections and with prolonged speaking. He also complained of morning hoarseness with increased phlegm and dry cough. One year earlier, he had been diagnosed by another otolaryngologist with a left hemorrhagic polyp and a right vocal fold nodule. The physician had recommended surgical excision and voice therapy, but the patient declined.

Our initial strobovideolaryngoscopic examination showed multiple large, irregular varicosities feeding a post-hemorrhagic polyp on the left vocal fold. One of the varicosities extended posteriorly along the vibratory margin. Extravasated blood was observed within and around the polyp along the midportion of the superior aspect of the vocal fold. Stroboscopy also showed scalloping of the contour of the vocal fold edge anterior and posterior to the polyp, and stiffness deep to the polyp along the vibratory margin. Prominent varicosities were seen on the superior surface of the right vocal fold; and one varicosity had multiple ectasias just lateral to a white, eliptoid, fibrotic contact mass. Both vocal folds were moderately erythematous. In addition, there was moderate arytenoid erythema consistent with reflux laryngitis.

The presence of a mass associated with vocal fold hemorrhage is prognostic of a poor recovery from hemorrhage and is a sign that satisfactory improvement in voice quality will probably require surgery. [1]

From the American Institute for Voice and Ear Research, Philadelphia (Dr. Dean and Ms. Hawkshaw), and the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University and Graduate Hospital, Philadelphia (Dr. Sataloff).

Reference

(1.) Spiegel JR. Sataloff RT, Hawkshaw M, Rosen DC. Vocal fold hemorrhage. Ear Nose Throat J 1996;75:784-9.