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36 year old female mother of two with a 4-year history of intermittent hoarseness. Nonsmoker, generally very healthy, regular exercise. Very talkative person with outgoing personality and work which requires constant talking both to groups and on a one-to-one basis. Reports that her family is also very loud in general. Gradual deterioration of voice over the past few years. Some environmental allergies.
On examination the patient displays moderate dysphonia and a mild strained quality in normal speech. During pitch-range exercises, voicing is intermittent but overall frequency range relatively normal. Preoperative audio clip below illustrates these traits.
Videostroboscopic examination reveals bilateral vocal cord masses, probably nodules, which impedes normal voicing. The vocal cords open and close normally in prephonatory adduction as seen in the preoperative stills) below. However, closure is not complete, due to the bilateral mass lesions.
Stroboscopic viewing of the moving vocal folds shows vocal cord motion inhibited by the presence of the masses. In the first video clip below, we see phonation in the lower end of the pitch range. Due to the thickening of the vocal folds required to produce low pitches, the nodules do not overly interfere with phonation. In the second preoperative video clip, we see the pitch breaking and hoarseness noted in the "baby bear" section of the audio recording above.
After about 6 months of voice therapy to try to relieve the nodules by non-operative techniques, it was decided to intervene surgically and remove the nodules using laryngeal microsurgical techniques. The patient was anaesthetised, and the nodules removed in a micro direct laryngoscopic procedure. The medial edge of the vocal cords was smoothed by cold dissection of the nodules, which were noticably larger in their inferior extent than seen in the intraoperative photographs below.
The postoperative audio sample below speaks for itself when compared to the preoperative audio sample. This sample is from a ten-day followup examination. The patient reports that she is able to sing again, and that her voice seems almost back to normal. The sample clearly shows that removal of the nodules has eliminated the pitch breaks which were occurring, and also shows an increased ease of phonation.
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