A 53-year-old man presented with a 2-year history of persistent hoarseness. His voice had become moderately raspy, with intermittent pitch breaks, and he noted increased vocal effort and fatigue and decreased vocal endurance. He had previously received a diagnosis of laryngopharygeal reflux and had been taking omeprazole (Prilosec) daily, without improvement. He also had cervical dystonia. He had no history of tobacco or alcohol use.
Physical examination via indirect laryngoscopy suggested a mass on the right true vocal fold. Laryngeal videostroboscopy revealed a spheroid, submucosal mass within the medial aspect of the anterior third of the right true vocal fold, which impaired glottal closure and regular vocal fold vibrations. The mass effect of the lesion resulted in a differential pliability within the right true vocal fold and between the 2 vocal folds. Vocal fold mobility was symmetrical bilaterally. Neck examination demonstrated cervical dystonia with no masses or lymphadenopathy. The results of the rest of the head and neck examination were normal.
Leu G, Klein AM, Deyrup AT, Johns MM. Pathology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2007;133(1):94. doi:10.1001/archotol.133.1.94
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