Prolonged ulcerative laryngitis.

We were visited by a 35-year-old music teacher in the public school system. She had been trained as a professional singer, but she used her voice professionally only in the classroom situation. She was a lifelong nonsmoker and nondrinker, and she had been treated in the past for gastroesophageal reflux disease. She came to us after a 2-year absence from our practice with complaints of hoarseness, harsh cough, sore throat, and fever.

Laryngeal examination revealed very edematous, mobile vocal folds with small nodular swellings and evidence of early laryngotracheitis. Initial treatment included amoxicillin, methylprednisolone, voice rest, continued use of her albuterol inhaler, and Robitussin as needed for cough. When she returned 1 week later for followup, she was still hoarse, and she had a persistent cough and generalized fatigue. Strobovideolaryngoscopy revealed severe vocal fold inflammation and ulceration, especially on the right vocal fold (figure). She was then placed on a 10-day course of clarithromycin, prednisone, and complete voice rest. She was seen weekly in the office, and she ultimately received slightly more than 1 month of treatment with clarithromycin, steroids, and vocal rest. Eventually, her voice and vocal fold appearance returned to normal.

This case study illustrates the nature of prolonged ulcerative laryngitis. This condition requires diligent surveillance and patience, as recovery time has been found to take from several weeks to several months from the time of the initial office visit.

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