Vocal fold nodules.A 25-year-old soprano presented with increasing vocal fatigue, decreased range, and breathiness in her upper register. Her symptoms first manifested 4 years earlier, when she contracted a viral infection that had been diagnosed as mononucleosis mononucleosis /mono·nu·cle·o·sis/ (-noo?kle-o´sis) excess of mononuclear leukocytes (monocytes) in the blood. chronic mononucleosis chronic fatigue syndrome. . Her vocal demands at that time were substantial, as she was preparing for her senior recital. She had had no voice complaints prior to then, although she never felt that her singing voice was particularly strong. Several months before coming to us, the patient sought care from a local otolaryngologist, who diagnosed vocal fold nodules. Voice therapy led to a resolution of her symptoms, but only temporarily. Meanwhile, she had taken on a stressful new job, and she subsequently developed symptoms of laryngopharyngeal and gastroesophageal reflux, including heartburn heartburn, burning sensation beneath the breastbone, also called pyrosis. Heartburn does not indicate heart malfunction but results from nervous tension or overindulgence in food or drink. , a globus sensation, morning hoarseness, and frequent throat clearing. The patient was referred to our office. Her medical history was significant for Hashimoto's thyroiditis, which had been diagnosed when she was 9 years old. She was taking levothyroxine, and the results of a recent thyroid function test thyroid function test, n one of several tests to evaluate the function of the thyroid gland. These include protein-bound iodine, butanol-extractable iodine, radioactive iodine uptake, and radioactive iodine excretion. were normal. Stroboscopic examination of the larynx demonstrated the presence of vocal fold nodules in the striking zone, ectasia on the superior surface of the right vocal fold, laryngopharyngeal reflux, and left 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 (figure). The patient again underwent voice therapy, and she improved. She continues to sing well, although she still experiences vocal fatigue when her voice demands increase. [FIGURE OMITTED] 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:
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