Posthemorrhagic vascular mass on the left true vocal fold. (Laryngoscopic Clinic).

We evaluated a 42-year-old mathematician and university professor who taught a full course load during the regular school year and two courses during the summer. He had noted that during the previous 3 years, he had difficulty speaking audibly in noisy situations. During the previous summer, he began to experience persistent vocal fatigue after he had read a long passage aloud in class. He had also experienced persistent hoarseness during the 8 months prior to our evaluation. The patient reported no antecedent illness or other vocal abuse. He had received multiple prior medical opinions from otolaryngologists, and he had been started on a proton-pump inhibitor for laryngopharyngeal reflux.

At our examination, strobovideolaryngoscopy revealed mild supraglottic hyperfunction, normal motion of the vocal folds, and a large vascular mass that was centered on the anterior third of the left vocal fold. A large varicose vessel was observed leading to the mass, and the entire left side of the vocal fold was discolored yellow and red. We also noted some thickening on the right vocal fold along the contact area as well as the presence of an anterior web. On stroboscopic examination, the left vocal fold exhibited a severely decreased amplitude and wave form.

The patient was prescribed a brief course of voice therapy to decrease his hyperfunction and to prepare him for safe phonation following surgery. He was then taken for microlaryngoscopy and excision of the left vocal fold mass (figure). After the laryngoscope was suspended, the left vocal fold was infused with saline-and-epinephrine solution. The vascular mass could not be elevated from the vocal ligament, indicating a deep fibrotic reaction attaching the mass to the vocal ligament. An incision was made along the superior surface of the mass, and the mass was carefully dissected from its deep attachments. During dissection, the vocal ligament was identified anteriorly and preserved. The remaining mucosal attachments were then incised, and the mass was sent for pathologic examination. A steroid was injected underneath the yellowish mucosa and into the region of the vocal ligament in an attempt to reduce the amount of scarring. The small anterior web was left undisturbed. Pathologic examination of the mass reve aled an organized hematoma without evidence of hemangioma.

The patient was kept on voice rest for 10 days postoperatively. He was then allowed to slowly increase his voice use under the close observation of a laryngologist (R.T.S.) and a speech-language pathologist. Six months following the procedure, the patient was happy with his voice. He still experienced stiffness underlying the area where the mass had been, but it had decreased substantially over time and his glottic closure was good.