Vocal fold masses and a varicosity in a professional singer.A 46-year-old man, a professional lounge singer, complained that his voice would crack while he was singing quietly. His difficulty had begun 6 years earlier after he had experienced a severe sore throat. Since then, the frequency of his vocal breaks had increased from twice nightly to 3 or 4 times per song. He also reported dry throat and frequent throat-clearing. He denied abrupt voice changes, vocal fatigue, and hoarseness while speaking. His medical conditions included headaches, arthritis, and gastroesophageal reflux. He was taking butalbital/acetaminophen/caffeine for his headaches and occasionally famotidine and omeprazole for heartburn.Strobovideolaryngoscopy detected a prominent left vocal fold varicosity varicosity /var·i·cos·i·ty/ (var?i-kos´i-te) 1. the quality or fact of being varicose. 2. varix. 3. varicose vein. var·i·cos·i·ty n. 1. , a left vocal fold cyst Vocal fold cysts are collections of fluid in sac-like formations on the vocal folds. Cysts can deteriorate the quality of human speech production, causing diplophonia, a condition where the vocal cords produce multiple tones at the same time, or dysphonia, an impaired , a right vocal fold reactive lesion, mild glottic glot·tic adj. 1. Of or relating to the tongue. 2. Of or relating to the glottis. glottic pertaining to (1) the glottis, or (2) the tongue. insufficiency, mild laryngopharyngeal reflux, and mild supraglottic compression (figure). Laryngeal electromyography demonstrated mild bilateral superior laryngeal nerve superior laryngeal nerve n. A branch of the vagus nerve at the inferior ganglion. At the thyroid cartilage, it divides into two branches, the internal, which supplies the mucous membrane of the larynx above the vocal cords; and the external, which paresis paresis /pa·re·sis/ (pah-re´sis) slight or incomplete paralysis. general paresis paralytic dementia; a form of neurosyphilis in which chronic meningoencephalitis causes gradual loss of cortical . The results of a neurologic evaluation were negative. [FIGURE OMITTED] The patient began speech and singing therapy, and he was started on a twice-daily proton-pump inhibitor and a nightly [H.sub.2] blocker. His singing schedule precluded vocal fold edge surgery, which requires a recovery period of 8 to 12 weeks. Instead, he underwent microdirect laryngoscopy with bilateral injection medialization laryngoplasty and varicosity removal. (At a later time, he may require removal of the masses. A staged procedure was discussed with the patient, and he agreed to it.) When evaluating benign nonemergent vocal problems in professional voice users, it is important to plan treatment that reasonably accommodates their vocal obligations. However, if stiffness develops at the base of a mass, if a mass enlarges, or if a varicosity hemorrhages, then surgical intervention is recommended and singing performances should be cancelled until healing is adequate. From the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University It began as Jefferson Medical College in 1824. On July 1, 1969 the institution officially became Thomas Jefferson University. The university is made up of three colleges:
Libby J. Smith, DO; Robert T. Sataloff, MD, DMA (1) (Digital Media Adapter) See digital media hub. (2) (Document Management Alliance) A specification that provides a common interface for accessing and searching document databases. |
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