This patient originally presented with a variceal bleed and was managed on ITU. Investigations confirmed alcoholic liver disease and the patient is entered onto a variceal ablation programme. At the first outpatient endoscopy, this is noted
WHAT IS THE LIKELY DIAGNOSIS?
■ Vocal cord granuloma
Looks like granulomatous tissue!
■ Mucus retention cyst
It doesn't look cystic !
Unlikely as wasn't noted at intubation
This is a vocal cord granuloma likely caused by irritation from the ET tube during the recent admission. Other causes include 'voice abuse', severe cough, vomiting, habitual throat cleaning, and the use of irritants such as tobacco and alcohol. Mucus cysts rarely develop on a vocal cord and look cystic rather than as granulomatous tissue as in this case.
Initially, management is supportive as these often shrink within 6-12 weeks. Surgery or laser ablation is reserved for large lesions but is a little fraught is these tend to recur unless to underlying cause is addressed. Singers should be advised to warm up the voice before singing (or speaking), resting the voice in anticipation of future speaking obligations and to avoid singing at times of an upper respiratory infection.
This excellent photograph of a vocal cord granuloma was actually supplied by Dr Muslim Alkafaji who has been a member of Friends of Endoscopy since 2014 !!!