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May 1979

Resident's Page

Author Affiliations

University of Virginia School of Medicine Charlottesville

Arch Otolaryngol. 1979;105(5):296-299. doi:10.1001/archotol.1979.00790170066021


Gary C. Lulenski, MD, St Joseph, Mich  A 35-year-old woman had a two-year history of progressive hoarseness and exercise intolerance. During a period of several days she became increasingly short of breath and noted an increasing nonproductive cough. Rather suddenly, she expelled a piece of tissue during a violent bout of coughing. She brought this tissue to an emergency room. There, she related with a very breathy voice that she had undergone a direct examination of her vocal cords one year previously, but that no abnormalities had been found. The specimen, presumed to be a blood clot, was, nevertheless, submitted to the pathology laboratory (Fig 1).The patient was seen three days later, but an adequate examination of the vocal cords could not be obtained because of hyperactive gagging. She stated that this had been a problem whenever attempts were made to examine the larynx. The

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