Asymptomatic anterior glottic web.
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A 65-year-old man with a history of asbestos exposure and leukoplakia presented for routine follow-up. He is a teacher and coach, and he denied having any vocal difficulties. Strobovideolaryngoscopy revealed an anterior glottic web involving half of the musculomembranous vocal fold. The web was present and unchanged from his initial visit 6 months earlier. He had complete glottic closure, but he now had a new leukoplakic lesion (figure 1). His dysphonia severity index was -0.88, which falls within the normal range for general voice use. (1) As he was happy with his voice, no treatment to address the web was indicated, and it was left undisturbed when the leukoplakia was removed.
Anterior glottic webs are often a significant cause of dysphonia, and at times they may compromise the airway. Evaluation should include a determination of both the longitudinal and vertical extent. (2) Strobovideolaryngoscopy and high-resolution computed tomography are helpful in mapping the web, and intraoperative assessment with a 70[degrees] telescope (figure 2) is invaluable for symptomatic patients who require treatment. However, not all webs are symptomatic. Even in dysphonic patients with webs, other causes should be sought, and one should not assume that the web is responsible for the voice complaints.
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Care should be taken in managing these lesions, especially when the web appears thick. Often, thick webs--and sometimes thinner webs--will have scarring where they attach to the medial surface of the vocal fold. Removing such webs may lengthen the vocal folds at the expense of exposing adynamic areas on the contact surfaces that will make voice quality worse. (3) If the web is asymptomatic, generally it should not be treated.
(1.) Hakkesteegt MM, Brocaar MP, Wieringa MH. The applicability of the dysphonia severity index and the voice handicap index in evaluating effects of voice therapy and phonosurgery. J Voice 2010;24(2):199-205.
(2.) Sataloff RT. Professional Voice: The Science and Art of Clinical Care. 3rd Ed., Vol. 3. San Diego: Plural Publishing, Inc; 2005:1177.
(3.) Rubin AD, Sataloff RT. Glottic web at the striking zone. Ear Nose Throat J 2005;84(2):70.
Jamie Eaglin, MD; Farhad R. Chowdhury, MD; Robert Thayer Sataloff, MD, DMA, FACS
From the Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond (Dr. Eaglin); and the Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia (Dr. Chowdhury and Dr. Sataloff).
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|Title Annotation:||LARYNGOSCOPIC CLINIC|
|Author:||Eaglin, Jamie; Chowdhury, Farhad R.; Sataloff, Robert Thayer|
|Publication:||Ear, Nose and Throat Journal|
|Article Type:||Case study|
|Date:||Oct 1, 2011|
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