Laryngeal aspergillosis.

A 17-year-old girl had an 8-month history of progressive hoarseness and vocal fatigue prior to being diagnosed with extensive laryngeal papillomatosis that involved the entire length of both vocal folds. Her medical management included voice therapy and a staged surgical excision of the papilloma.

The first procedure entailed a cold excision of the massive left vocal fold papilloma. The second procedure was performed 6 weeks later. At that time, a severe, aggressive recurrence on the left side was noted. The new mass was resected, but the extent of the excision of the right papilloma was limited in order to prevent webbing.

A strobovideolaryngoscopic examination 3 weeks following surgery revealed the presence of a white eschar on the left, which featured black speckles at, above, and below the level of the glottis (figure 1). These speckles had not been present during her visit 1 week following surgery. The diagnosis was laryngeal aspergillosis.

The patient also had a large papilloma posteriorly on the right vocal fold and anteriorly just above the vocal fold to the right of the anterior commissure. A third surgical procedure was postponed, and the patient was placed on antifungal therapy with systemic fluconazole. The stigmata disappeared after a 3-week course of the fluconazole (figure 2).

Isolated laryngeal aspergillosis is rare. Initially, empiric treatment without biopsy might be appropriate in systemically immunocompetent patients, as long as the physician maintains close followup.

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