The value of varying vocal frequency during stroboscopy for vocal fold masses.

A 31-year-old female cantor came to us complaining of breathiness of her singing voice. She had been seen in our office 1 year earlier for treatment of bilateral vocal fold masses. At that time, she was successfully treated with voice therapy and a reflux medication. She returned to her work as a cantor and was doing well until she developed the breathiness.

Stroboscopic examination at a high pitch revealed a left-sided hemorrhagic vocal fold mass with increased size of the right mass at the point of contact (compared with the previous year, not shown) (figure 1). We also observed stiffness at the base of the right mass and irregular vessels anteriorly.

[FIGURE 1 OMITTED]

Repeat stroboscopic examination at a lower pitch provided a better view of the contact margin on the left side (figure 2). The extent of submucosal hemorrhage was much more apparent than it was during the examination at the higher pitch, when only the superior surface was seen well. The lower-pitch examination also demonstrated right ectasia secondary to contact trauma, which was not seen during phonation at the higher frequency.

[FIGURE 2 OMITTED]

The patient underwent microdirect laryngoscopy with excision of the vocal fold masses and bilateral vocal fold injection of dexamethasone. She returned to the office after 1 week of vocal rest and was healing well. Three weeks later, she had greater-than-expected left vocal fold stiffness on stroboscopic examination. One week later, she underwent microdirect laryngoscopy with bilateral vocal fold dexamethasone injection. Injections were made at the base of the left vocal fold scar in the region of the striking zone and submucosally in the region of the right vocal fold scar. She returned 1 week later and described her voice as normal; her vocal folds showed much less stiffness on stroboscopy.

From Thomas Jefferson University Hospital, Philadelphia (Ms. Tereschuk), and the Department of Otolaryngology--Head and Neck Surgery, Graduate Hospital, Philadelphia, and the Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University, Philadelphia (Dr. Sataloff).