The effects of yelling in loud, smoky bars. (Laryngoscoplic Clinic).A 30-year-old woman sought treatment for an 8-month history of hoarseness of sudden onset. She worked as a clothing buyer for a chain of women's boutiques, and she would speak on the telephone for as many as 14 hours per day. Approximately 8 months prior to her office visit, she had lost her voice (unable to phonate pho·nate (f   n t )v. ) after she had attended a party. She regained her voice function 5 days later after she took an antibiotic and a steroid. However, 3 months later she lost her voice again. She again sought treatment and experienced only a partial recovery (some lingering hoarseness). Her voice was worst on those mornings after she had stayed out late in noisy bars and had spoken very loudly. Strobovideolaryngoscopy revealed mild right superior laryngeal nerve paresis general paresis paralytic dementia; a form of neurosyphilis in which chronic meningoencephalitis causes gradual loss of cortical function, progressive dementia, and generalized paralysis. pa·re·sis (p  -r (later confirmed by electromyography electromyography /elec·tro·my·og·ra·phy/ (EMG) (-mi-og´rah-fe) the recording and study of the electrical properties of skeletal muscle.electromyograph´ic), uncontrolled laryngopharyngeal laryngopharyngeal /la·ryn·go·pha·ryn·ge·al/ (lah-ring?go-fah-rin´je-al) pertaining to the larynx and pharynx or to the laryngopharynx.la·ryn·go·pha·ryn·geal (l -r reflux, and bilateral vocal fold masses with associated abnormal blood vessels. The entire right vocal fold was yellowish except for areas in the striking zone around the mass that were erythematous (figure 1). This appearance suggested a recent hemorrhage with partial resorption 1. the lysis and assimilation of a substance, as of bone. 2. reabsorption. re·sorp·tion (r  -sôrpsh. Stroboscopy revealed substantial stiffness at the base of both masses. The patient underwent a course of voice therapy to correct her maladaptive speech patterns, but she remained unhappy with her vocal quality and endurance. Repeat videostroboscopy showed resolution of the yellow and red discoloration of the vocal folds but persistent bilateral fibrotic masses with underlying scar. After we discussed the available options at length, the patient elected to undergo microlaryngoscopy and resection of the masses (figure 2). In addition to mini-microflap excision 1. Surgical removal by cutting, as of a tumor or a portion of a structure or organ. Also called exsection. 2. A recombination event in which a genetic element is removed. Postoperatively, the patient experienced a significant improvement in her vocal quality and endurance, and she returned to work without restrictions. From the Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University, Philadelphia. |
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