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CASE December 2021

J. is a 66-year-old man who consults the voice clinic because of recurring episodes of hoarseness. He went through a COVID-19 infection five months ago and has been coughing a lot. His voice was hoarse, but this recovered completely afterwards. After his first COVID-19 vaccination two months ago, Mr. was slightly hoarse again, with an improvement after two weeks. Since the last vaccination six weeks ago, the hoarseness has reappeared and continues to persist.

He does not rate his own hoarseness as serious (VAS scale: 3/7). He rates his speech activity as low-average (VAS scale: 3/7) and his loudness as average (VAS scale: 4/7). He does not carry out any further voting activities and has never smoked. He notes that his voice does not vary during the day unless after voice stress. He actually remains constantly hoarse and also has to cough and clear his throat regularly. He has no other throat complaints.

Self-report shows that the voice does not limit him in daily life (VHItotal: 17/120), with the physical aspects disturbing him most (Physical: 9/40; Functional: 5/40 and Emotional: 3/40). His motivation to do something about his voice problem is quite high (VAS scale: 5/7). On the Voice Handicap Index-Throat (VHI-T) he scores 6/40. The objective voice analysis shows that he achieves a DSI of 2.18  and an AVQI of 3.44.

The laryngostroboscopic examination shows the following images:

Listen to the sound fragment: 

What is your GRBAS score?

What do you think the diagnosis would be?

What would your treatment proposal be?


The laryngostroboscopic image shows a tumor at the middle 1/3 of the left true vocal fold with several hyperkeratotic plaques and extension to the subglottis margin. The anatomopathological examination indicates a low-grade squamous dysplasia with focal zones of high-grade dysplasia. It is a benign tumor with zones of restless cells, which may be precancerous. The wave pattern is present on stroboscopy, but the glottal closure on phonation is suboptimal. Vocalization is overall good with an auditory perceptual rating of G1R0B1A0S0.


The treatment consisted of excision of the vocal cord tumor via direct laryngoscopy by means of a CO2 laser in the form of a left superficial cordectomy. This means that the tumor is removed closely while sparing the surrounding healthy tissue.

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On inhalation

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Phonation in chest register

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Phonation in falsetto register

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On inhalation

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On inhalation

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