A 22-year-old theater actress presented with a complaint of a sudden inability to sing higher than her midrange during a theatrical performance. She recalled that she had experienced a painful, violent sneeze just prior to her performance. Videostroboscopy revealed small bilateral mass lesions (arrowheads) on her vocal folds and a white lesion at the contact surface of the mass (figure). The white lesion represented a mucosal tear. After evaluation, the patient modified her part and was permitted to perform one final show. After that show, her symptoms and findings had worsened. She then completed 4 days of absolute voice rest, and her condition improved.
Mucosal tears occur at points of maximum shear force, which are almost always located in the middle of the musculomembranous portion of the vocal fold in the striking zone. This is also the area where nodules and cysts most often form. A feared complication of mucosal tears is scarring of the vocal fold. Our patient's tear was located over an area of previous scarring (a fibrous mass lesion), which reduced her risk of clinically significant permanent damage.
Three factors entered into our decision to allow our patient to perform one more show after our initial evaluation: she was not hoarse, she was able to modify her part, and she had no understudy. Had her tear been on an area of normal mucosa, we would have placed her on voice rest immediately.
Mark A. Ginsburg, DO; Robert L. Eller, MD; Robert T. Sataloff, MD, DMA
From the Department of Otolaryngology/Facial Plastic Surgery, Philadelphia College of Osteopathic Medicine (Dr. Ginsburg); the Department of Otolaryngology--Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Tex. (Dr. Eller); and the Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia (Dr. Sataloff).
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|Title Annotation:||LARYNGOSCOPIC CLINIC|
|Author:||Ginsburg, Mark A.; Eller, Robert L.; Sataloff, Robert T.|
|Publication:||Ear, Nose and Throat Journal|
|Article Type:||Brief article|
|Date:||Oct 1, 2008|
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