Pedunculated granuloma of the vocal fold.

A 29-year-old man came to the office with a 2-week history of hoarseness and fluctuating voice quality, particularly an abnormally high pitch. During the 48 hours prior to our examination, he had had unremitting hoarseness without periods of normal voice quality. Three months before the onset of his vocal difficulties, he had undergone an emergency splenectomy, which was followed 1 week later by an exploratory laparotomy to repair a hemorrhaging splenic artery. Although there were no reported intubation difficulties, a nasogastric tube had been left in place for several days after the second procedure.

We performed strobovideolaryngoscopy (not shown), which revealed signs of reflux laryngitis and a large granuloma near the left vocal process. Voice therapy, antireflux drugs, and corticosteroids were not able to eliminate the mass or restore his voice quality to normal. At surgery, a large granuloma was still present near the left vocal process (figure 1). Retraction of the mass with suction revealed that it was pedunculated and attached to a relatively small area (figure 2). The vasculature supplying the mass was seen prominently lateral to the pedicle. Pathology revealed polypoid granulation tissue.

Following surgery, the patient's voice returned to normal. He has continued on antireflux therapy and has had no recurrence of either his mass or dysphonia.

From the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University (Dr. Sataloff and Dr. Spiegel), and the Department of Otolaryngology-Head and Neck Surgery, Graduate Hospital (Dr. Sataloff, Dr. Lyons, and Dr. Spiegel), Philadelphia.