Hemorrhagic polyp (1 of 4)
Hemorrhagic polyp, right cord. Notice the “blood blister” appearance. Recent further bleeding evident from yellowish discoloration of upper surface of the cord, due to breakdown products of a bruise, estimated two weeks earlier. Hemorrhagic polyps sometimes re-bruise intermittently.
Hemorrhagic polyp (3 of 4)
Vocal cords are coming into vibratory contact, beginning of closed phase.
Hemorrhagic polyp (4 of 4)
Closed phase of vibration, strobe light, showing that the polyp shifts to upper surface of the vocal cord.
Hemorrhagic polyp: 1 week after surgery (4 of 8)
Same patient, one week after surgical removal of the polyp, standard light.
Hemorrhagic polyp: 1 week after surgery (5 of 8)
Strobe light, open phase of vibration. Compare with photo 2. Note here that the vibratory amplitude of both cords is the same, showing that the operated cord remains flexible.
Hemorrhagic polyp: 1 week after surgery (6 of 8)
Strobe light, closed phase of vibration. Compare with photo 3; the vocal cords now match much better during voicing, and the voice is completely normalized.
Hemorrhagic polyp: 7 months after surgery (7 of 8)
Seven months later. Strobe light, closed phase of vibration. The patient feels his voice is normal, and swelling checks don't indicate any impairment.
Hemorrhagic polyp, treated by thulium laser (1 of 8)
Hemorrhagic polyp, right vocal cord (left of image). This professional singer has struggled with severe limitations for six months. Note the feeding vessel, both anterior and posterior to the polyp, at arrows. These will be the first target of treatment.
Hemorrhagic polyp, treated by thulium laser (2 of 8)
Using near-contact mode with a thulium laser, the feeding vessels have been coagulated, to reduce bleeding when the polyp itself is addressed. In contrast to what would be seen with a pulsed-KTP laser, one can see here hazy superficial coagulation affecting epithelium surrounding the vessels—so superficial that it will not affect vibratory flexibility.
Hemorrhagic polyp, treated by thulium laser (3 of 8)
The remaining laser energy is delivered to the polyp in contact mode, while stretching it away from the cord.
Hemorrhagic polyp, treated by thulium laser (4 of 8)
At the conclusion of the procedure, the polyp is released from the fiber. There is no damage to the vocal cord surrounding the polyp. A follow-up visit will be scheduled as "possible laser," in case there is any residual polyp that did not slough off.
12 weeks after thulium laser treatment (5 of 8)
Twelve weeks after removing the hemorrhagic polyp via thulium laser. View under standard light, at the pre-phonatory instant. Both the patient and physician regard the patient's voice as completely normal in quality and capabilities.
12 weeks after thulium laser treatment (6 of 8)
During phonation, with vibratory blur. Standard light.
12 weeks after thulium laser treatment (7 of 8)
View under strobe light. During phonation, at the closed phase of vibration, for the pitch B-flat 4 (~466 Hz).
12 weeks after thulium laser treatment (8 of 8)
Open phase of vibration, also at B-flat 4 (~466 Hz).
Capillary ectasia and hemorrhagic polyp, after treatment (3 of 4)
Abducted breathing position after vocal cord microsurgery, standard light. Note that the right cord is normalized, the capillary ectasia on the left is smaller, but persists in spite of spot-coagulation. A simple pulsed-KTP laser procedure in the videoendoscopy procedure room abolished this residual lesion.
Capillary ectasia and hemorrhagic polyp, after treatment (4 of 4)
Pre-phonatory instant, standard light, showing excellent match. Oscillatory ability entirely normal into extreme upper range in this professional singer.
Capillary ectasia and hemorrhagic polyp (1 of 2)
Note the differing patterns of capillary ectasia—fine “stream;” meandering “river,” and “pond.” Brilliant white areas are reflection of light; more indistinct submucosal white area right cord raises question of possible cyst (arrow).
Capillary ectasia and hemorrhagic polyp (2 of 2)
Strobe illumination better reveals the polypoid component of the swellings. Some mucus accumulation, especially posteriorly.
Capillary ectasia and hemorrhagic polyp (1 of 7)
Open position for breathing, standard light. There is capillary ectasia on both vocal cords, and there is also a hemorrhagic polyp of the left vocal cord margin (right of photo).
Capillary ectasia and hemorrhagic polyp (2 of 7)
During voicing, the polyp interferes with accurate approximation of the vocal cords, which explains this man's chronic hoarseness.
Capillary ectasia and hemorrhagic polyp, thulium laser treatment (3 of 7)
Using the thulium laser to spot-coagulate and interrupt the flow in dilated capillaries.
Capillary ectasia and hemorrhagic polyp, thulium laser treatment (4 of 7)
Coagulation of the polyp, with fiber tangential to the vocal cord and sometimes lifting medially during contact mode. A second, similar procedure was needed a few weeks later, only for residual polyp.
Capillary ectasia and hemorrhagic polyp, after treatment (5 of 7)
Several weeks later, capillary areas are blanched, but the vocal cord mucosa is fully mobile.
Capillary ectasia and hemorrhagic polyp, after treatment (6 of 7)
Vocal cord margin match and mucosal flexibility are best tested in high voice. This is strobe light, closed phase of vibration, at F4 (~349 Hz).
Capillary ectasia and hemorrhagic polyp, after treatment (7 of 7)
Also at F4 (~349 Hz). The mucosa of both cords is completely supple. The patient considers his voice to be perfectly normal—"original equipment."
Young woman with hoarse voice (1 of 8)
Young woman who fits the "vocal overdoer" profile and who has been hoarse for many years. The hoarseness has become intolerable in the past 2 months.
Inspiratory phonation (2 of 8)
At much closer range, with the right polyp (left of photo) displaced with inspiratory phonation to show the considerable left cord (right of photo) injury. Note large vessel coursing along the right polyp (left of photo) and the capillary prominence within the left vocal cord (right of photo) injury as well. Note as well the bruising distant from the origin and yellowish discoloration of partially resolved bruising.
Open phase, rumble (5 of 8)
At F3 (175 Hz), open phase of vibration. At this pitch the polyp flutters and adds a second low rumbling sound to the main pitch she is singing.
Closed phase, segmental vibration (6 of 8)
The patient sings B-flat 5 (932 Hz) using only the posterior segment with vibration indicated by bi-directional arrows.
One week post-op, prephonatory instant (7 of 8)
One week after surgical removal, prephonatory instant, at C5 (523 Hz). Note the gap between the cords, much the same as preoperatively in prior photos.
One week post-op, phonation (8 of 8)
Phonation also at C5. Vibratory blur is equal bilaterally, and upper voice dramatically restored, even before “surgical laryngitis” has resolved.