Mid-Glottic Web in a Professional Voice User in the Setting of Upper Respiratory Infection.

Abstract

Mid-glottic webs are a rare pathology of the vocal folds, with cases only documented within the last decade. The pathophysiology behind the location of this vocal fold lesion may be attributed to the mid-vocal fold being the site of maximal mechanical stress during phonation. While anterior glottic webs and posterior glottic stenosis are well-described vocal fold pathologies, only 4 cases of mid-membranous webs have been reported to date. We present the first case of a mid-glottic web not attributable to smoking, radiation, or intubation, in a 45-year-old female teacher who developed chronic dysphonia in the setting of occupational voice use and prior upper respiratory tract infection. She was treated surgically with cold instrument lysis of the adhesion via microdirect laryngoscopy. Her dysphonia improved without residual web at her 4-month postoperative visit, but she did develop vocal fold nodules. A thorough evaluation of acute dysphonia and dyspnea in heavy voice users should include a workup for this rare laryngeal pathology, particularly given its significant negative impact on the ability of occupational voice users to work, followed by proper postoperative voice therapy and vocal hygiene.