A 48-year-old woman presented with chronic cough and hoarseness that had become progressively worse over the preceding 6 months. Her history was significant for cigarette smoking (50 pack-yr) and moderate alcohol use (3 highballs/day). A previous microlaryngoscopy with biopsy had detected chronic inflammation and mild dysplasia of the vocal folds.
A granulomatous or autoimmune process was suspected based on findings of stroboscopy (figure). Findings on laboratory evaluations--including measurements of c- and p-antineutrophil cytoplasmic antibody (c-ANCA and p-ANCA), angiotensin-converting enzyme (ACE), antinuclear antibody (ANA), erythrocyte sedimentation rate (ESR), sputum acid-fast bacilli (AFB), and a complete blood count--were normal. The immunoglobulin E (IgE) level was mildly elevated at 233 U/ml. Findings on chest radiograph and pulmonary function testing were normal.
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A pulmonary consultation was obtained, and smoking cessation measures were begun. The patient was aggressively treated for laryngopharyngeal reflux and allergy with esomeprazole, nizatidine, montelukast sodium, and fluticasone. She was scheduled for repeat microlaryngoscopy and biopsy for tissue diagnosis.
Three months later, she returned for a preoperative visit. Her laryngeal exam showed dramatic improvement, and surgery was cancelled. She continues to struggle with smoking and alcohol cessation.
From the Anderson Center for Voice and Swallowing, Houston (Dr. Beaver), and the Texas Voice Center, Houston (Dr. Stasney and Dr. Rodriguez).
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