Sessile vocal fold polyp, contralateral reactive vocal fold mass, anterior glottic microweb. (Laryngoscopic Clinic).

A 28-year-old telephone coordinator and housewife came to the office for an evaluation of hoarseness. She reported a lifelong history of hoarseness that worsened with extensive speaking. Six months prior to her visit, she experienced a sudden onset of hoarseness after yelling. The dysphonia persisted for 6 weeks before she sought medical consultation.

The woman was evaluated by an otolaryngologist, who diagnosed reflux laryngitis, prescribed lansoprazole twice daily, and recommended voice rest. She adhered to the voice rest for 4 days. Her voice quality improved, but she continued to have problems with vocal fatigue and muscle tension in her throat with extensive speaking. She had occasional hoarseness in the morning, but denied throat clearing or heartburn. She had no previous medical problems, and her current medications included only oral contraceptive pills.

On examination, the patient's voice was moderately breathy and moderately hoarse. Strobovideolaryngoscopy revealed the presence of a broad-based sessile polyp that was centered in the striking zone and which occupied more than one-third of the right musculomembranous vocal fold (figure 1). There was considerable stiffness at its base. On the left vocal fold, there was a soft, crater-like, reactive mass centered in the striking zone. Also noted was an anterior glottic microweb that did not appear to be symptomatic (figure 2). The superior surface of both vocal folds featured fine varicosities that were perpendicular to the vibratory margins and entered into the bases of the masses. Glottic closure was incomplete anteriorly and posteriorly to the masses.

The amplitude and waveform of the mucosal wave were moderately decreased on the right and mildly to moderately decreased on the left. Vibratory function was hypo-dynamic in the middle and posterior thirds of the musculomembranous portion of the right vocal fold. The left vocal fold was hypodynamic in the middle third of the musculomembranous portion. The arytenoid cartilage was mildly erythematous and edematous, and there was a mild to moderate degree of posterior cobblestoning consistent with reflux laryngitis. Findings of the remainder of the head and neck examination were normal.

The patient was treated with voice therapy, placed on a proton-pump inhibitor twice daily, and prescribed other antireflux precautions. Her voice improved somewhat with therapy, but not satisfactorily. She underwent resection of the masses, and she was happy with her voice 2 months postoperatively.

From the University of Illinois at Chicago (Dr. Heman-Ackah), and the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia (Dr. Sataloff).