Persistent Vocal Fold Hemorrhagic Polyp

Significance Statement

Vocal fold masses are common for professional voice users, but with early intervention through voice therapy and proper voice care, they can often be managed or prevented. When necessary, surgery can provide relief and improve voice function, but prevention remains the best strategy for maintaining vocal health.

This 48-year-old music teacher presented with persistent hoarseness that had been present for approximately 12 years. She had a history of “vocal fold nodules” and had been treated with voice therapy, but her voice had never returned to normal. She also reported vocal fatigue and pain with swallowing after extensive voice use. Strobovideolaryngoscopy revealed a left vocal fold pedunculated, hemorrhagic polypoid mass with reactive scarring and stiffness on the right vocal fold. In addition, there were extensive vocal fold varices and perpendicular vessels extending to the vibratory margins (Figure 1). This mass interfered with glottic closure (Figure 2). Laryngeal electromyography revealed 25% to 30% decreased recruitment in the left superior laryngeal nerve. Perceptual assessment of the voice revealed moderate-to-severe hoarseness and mildly reduced volume. These impressions were supported by abnormal objective voice measures. The Voice Handicap Index was 22. After intensive voice therapy, the lesion was excised, dexamethasone was injected bilaterally, and selected vessels were obliterated with a pulsed potassium titanyl phosphate laser. Her laryngeal appearance and voice improved markedly even 1 week following surgery. Excellent healing is seen on postoperative day 8. She continued to improve on 6-week follow-up (Figure 3). The patient had virtually no dysphonia.

Figure 1.

Left vocal fold hemorrhagic polyp in abduction.

Figure 2.

Left vocal fold hemorrhagic polyp in adduction, glottic insufficiency.

Figure 3.

Six weeks post excision of left vocal fold hemorrhagic polyp.