Laryngeal and subglottic amyloid.

We examined a 42-year-old seaman who had undergone knee surgery 4 weeks earlier. He remarked that he became hoarse after surgery; he had not previously experienced hoarseness. He denied symptoms of airway compromise postoperatively, and he had no other history of intubation, trauma, or laryngeal surgery. The surgery had limited his physical activity. Prior to our examination, he had been treated with a high-dose proton-pump inhibitor, but had experienced no improvement.

Videostroboscopy detected a near-circumferential sub-glottic subepithelial infiltrate with focal areas of nodularity (figure). A laboratory workup--including a rapid plasma reagin test and assays for human immunodeficiency virus, antinuclear antibodies, and both c and p antineutrophil cytoplasmic antibodies--were negative. His erythrocyte sedimentation rate was 6 mm/hr, and his angiotensin-converting enzyme level was 27 nmol/ml/min. Findings on radiographic evaluation for systemic involvement (anteroposterior and lateral views of the chest) were negative. Pulmonary function parameters were within normal limits.

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Direct laryngoscopy and biopsy were performed with general anesthesia and spontaneous ventilation. Pathology was consistent with laryngeal amyloidosis. The patient deferred further treatment, and the results of his follow-up examinations have been stable since.

From the Texas Voice Center, Houston.