Vocal Fold Granuloma Induced by Rigid Bronchoscopy

Abstract

Vocal fo ld granulomas secondary to endotracheal intubation, vocal abu se, and laryngophar yngeal reflux are a well-described cause of hoarseness, generally in the adult population. The mean age ofonse t is usually in the f ourth orfifth decade, and the position is most commonly on the vocal process or one of the arytenoids.J We present an atyp ical case involving a pediatric patient with a large, anterio r, tru e vocal f old granulomafo llowing rigid endo scopy of the upp er conductive airway. Case Report A 10-year-old girl was referred to the Department of Otol aryngology-Head and Neck Surgery at the Medical College of Virginia of Virginia Commonwealth University for evaluation of worsening dysphonia. Her history was significant for intermittent respiratory distress resulting in multiple cyan otic episodes and several hospitalization s over a 4-month period. Pediatric gastroenterology, allergy , and pulmo nary evaluations were repo rted to be nega tive. During one par ticularly significan t episode, she was tran sferre d from the emergency room to the operating room , where an airway evaluation under anesthesia was performed by pediatric surgery. Acute respiratory decomp ensation in the operating room upon induction resulted in urgent intubation with a rigid bronch oscope through a closed glottis. Ventilation was estab lished, and the procedure was completed. There was no glottic, trac heal , or bronchial anatomic abnormality reported , with the exception of minor refl ux cha nges in the interary tenoid region, and there was no foreign body. The presumed laryngospasm or bronchospasm subsequently subsided during the course of her endo scopy. The bronch oscope was removed and the patient awakened