Voiceless 50-year-old man (1 of 6)
This 50-year-old man is virtually aphonic. The vocal cord abnormality is already visible in this distant view.

Vascular stippling (2 of 6)
At closer range and under standard light, the vascular stippling is becoming more visible. The two small 'X's are for reference with Photo 3.

Narrow band light, vascularity (3 of 6)
At even closer range under narrow band light, the vascularity is even more evident. The two small 'X's are for reference with Photo 2.

4 months later, recurrent papillomas (4 of 6)
This man had marked improvement of voice after surgery 4 months earlier but within weeks, voice began to deteriorate due to regrowth of his papillomas.

Open position, narrow band light (5 of 6)
Still in open (breathing) position but now under narrow band light. The stippled vascular markings typical of HPV effect are seen more clearly.

Closing for voicing (6 of 6)
As the cords come into approximation for voicing, still under narrow band light, the recurrent lesions are again seen.