Medial margin evaluation in large, overlapping vocal fold lesions.

A 42-year-old rabbi presented with a 2-year history of gradually progressive dysphonia. He complained of hoarseness, voice fatigue, decreased projection, and increased vocal effort. The patient was a teacher, who taught class 8 to 10 hours daily. He had received "voice therapy" from a colleague who was a singer, and it helped somewhat. The patient also had significant reflux laryngitis. Strobovideolaryngoscopy revealed a large left vocal fold polyp, with a right contact lesion.

Following 2 months of voice therapy and treatment for reflux, the patient was taken to the operating room for removal of both lesions. From the usual perspective, the broad-based left vocal fold polyp obscured the right vocal fold mass (figure 1); the mass became visible when the polyp was retracted. Abnormal vasculature was also visible on the superior surface of each vocal fold. Examination through a 70[degrees] laryngeal telescope clarified the relationship between the right mass and the overlying left polyp (figure 2). The right contact lesion was found to be much more firm and fibrotic than the larger left vocal fold polyp. The patient's voice improved markedly following surgery. He felt that his vocal quality was essentially normal and he resumed his usual vocal activities.

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