Posthemorrhagic polyp.

A 27-year-old Web site designer experienced sudden hoarseness after yelling at a sporting event. Over the next 6 to 8 weeks, he experienced a general, but incomplete, improvement in his voice. Following a videostroboscopic examination (figure), he was diagnosed with a posthemorrhagic vocal fold polyp. The transglottal airflow could be seen pushing the mass out of the glottis, and the vocal folds vibrated underneath it. As a result, the contact area on the left vocal fold was thickened and might have been permanently scarred, especially on the superior surface. The middle and lower lip of the left vocal fold was essentially normal.

[FIGURE OMITTED]

The primary pathology seen in this image is the right vocal fold polyp, but a slight scalloping of the vocal ligament at the base of the polyp can also be seen. The scalloping suggests that a slight concavity in this area will appear after the polyp is surgically removed. Note the general hypervascularity of the vocal folds, especially the feeding vessel that travels perpendicular to the long axis of the vocal fold. The presence of this "pointer" vessel, along with the slight yellowing of the vocal fold and the history of sudden voice loss after yelling, suggests a remote hemorrhage as the cause of this lesion.

After the patient's laryngopharyngeal reflux was controlled and he had undergone a brief period of preoperative voice therapy, the lesion was removed under general anesthesia. The left side was palpated and found to be slightly firm, and it was therefore injected with steroids. The hoarseness resolved completely, and the patient was happy with his voice.

Robert Eller, MD; Mary Hawkshaw, RN, BSN, CORLN; Robert T. Sataloff, MD, DMA 

From the American Institute for Voice and Ear Research (Dr. Eller and Ms. Hawkshaw) and the Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine (Dr. Sataloff), Philadelphia.