Systemic lupus erythematous (SLE) is an autoimmune disease commonly treated with steroid which leads to immunosuppression and increased susceptibility to infection. Chronic laryngitis with whitish lesion on the true vocal fold in SLE may be caused by opportunistic organisms, such as tuberculous, fungal and Staphylococcus aureus infections. Videolaryngostroboscopy may be helpful in leading to the diagnosis and optimum treatment of glottic S. aureus A woman in her 40s with SLE presented with progressively worsening hoarseness for 2 months, accompanied by sore throat and odynophagia. Videoendoscopy showed erythematous and oedematous bilateral vocal fold with whitish lesion seen at the edge of middle one-third while the videolaryngostroboscopic evaluation showed there was severe asymmetry of the bilateral vocal folds, with severely reduced amplitude during phonation where the vocal cords were not vibrating, aperiodic vibratory cycles and 'always open', incomplete closure of vocal cord pattern. Later, endolaryngeal microsurgery and biopsy of the lesion confirmed of glottic S. aureus Her symptoms and followed up videolaryngostroboscopy showed resolution to normal findings after 6 weeks of cloxacillin. S. aureus infection of the glottis is a differential diagnosis in a chronic laryngitis with leucoplakic lesion in an immunosuppressive patient. Videolaryngostroboscopy has an important role in diagnosis, evaluation and treatment decision.
Laryngeal hemangiomas are relatively rare. Laryngeal hemangiomas occur in two main forms--infantile and adult laryngeal hemangiomas. While infantile hemangiomas are usually found to occur in the subglottis, adult hemangiomas occur commonly in the supraglottic regions of the larynx. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present a case of hemangioma of the right vocal cord in an adult, which was managed successfully in our center.
Vocal fold sulcus is a cause of dysphonia which has not been recognized until recently. Awareness of its existence combined with use of laryngostroboscopy would enhance the management of this group of patients. Five such cases were treated initially by voice therapy and subsequently combined with microlaryngeal Teflon injections of the vocal cord. Representative photomicrographs and the end results of treatment are presented. A good voice, subjectively and objectively, was obtained in three patients, with satisfactory improvement in the other two.
A 30-year-old Chinese lady was admitted for hoarseness of voice of one month's duration. Clinical examination revealed a granuloma of the left vocal cord while chest X-ray showed an opacity in the lower lobe of the right lung. The provisional clinical diagnosis was tuberculous laryngitis. A biopsy of the vocal cord lesion revealed inflamed tissue with actinomycotic colonies. Cultures and sputum smears did not reveal any tuberculous bacilli. The patient responded to a 6-week course of intravenous C-penicillin, regaining her voice on day 5 of commencement of antibiotics. A subsequent CT scan of the neck and thorax revealed multiple non-cavitating nodular lesions in both lung fields, felt to be indicative of resolving actinomycosis. She was discharged well after completion of treatment. It was felt that this is a case of primary actinomycosis of the vocal cord with probably secondary pulmonary actinomycosis.