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The patient is 32 year old female who has noted gradual worsening of her voice over the past year and a half. She is not a voice student and is unsure if technique is contributing to her problem. She has noted a significant increase in sinus symptoms, including postnasal drip, and has had frequent illnesses requiring antibiotic treatment. When she does not take her antibiotics after symptom onset, she feels sicker and the illness eventually progresses to her chest. The patient has not noted any changes to her lifestyle or diet but did move to a new home in a different city one year ago. She had sinus surgery in the past year to address these infections and has also experienced allergy and asthma flare-ups.
The patient’s general ENT exam was within normal limits. She had marked cobblestoning of the back of her throat (pharynx). Her videostroboscopy exam is as follows:
The stroboscopy exam demonstrates significant stiffening of both vocal folds. The still image emphasizes the excess vascularity and inflammation of the vocal folds. It is interesting to note that there is no distinct vocal fold injury (i.e. nodules, polyps, etc). Rather the entire vocal fold is very stiff and non-compliant, suggesting that there is something affecting the whole vocal fold.
It was determined that in light of her history and the appearance of her vocal folds, this appearance represents inflammation, likely due to inhalation and postnasal drip. The severity was far beyond what one would expect from this, however, the history and the picture did not suggest any other possibilities.
Treatment was instituted and her post-treatment stroboscopy was performed 2 weeks later:
The picture and video demonstrate significant improvement in the mucosal wave, laryngeal mucous, and general inflammation of the vocal folds.
Interestingly, in this case, the patient’s recent move was to a city with poor air quality. Her allergy testing was completely negative, which indicates all the inflammation we saw was due to inhalation injury from air quality alone. This disturbing finding is something we must really take into account, as professionals who care for touring musicians. Getting singers on appropriate respiratory health regimens may be the only thing needed for them to stay out of trouble while on tour.
To learn more about Dr. Reena Gupta or vocal nodule evaluation and treatment, please visit www.voicedoctorla.com.
