Behavioral injury

Stroboscopic view at pitch A2 during mid closure. Both polyps being blown toward the viewer superior surface of the vocal cord

History 57 year old female Complaints 20 years ago her voice began deepening. Now many of her clients think she is a man when on the phone with her. This is causing problems with her business. At times her voice actually stops and only air comes out. She cannot yell.

a polyp that extends the length of the vocal cord in a smoker

Reinke's Edema, otherwise known as smoker’s polyps. Most commonly found in talkative people who smoke. Usually on both vocal cords, though it may be present on only one. They can be asymmetric and here the left one is much larger than the right.

During phonation, the smokers polyp tends to ride on the superior surface of the vocal cord.

A 25 pack year smoker was not bothered by the deep pitch of her voice but her doctor suggested she get a check up for cancer. The clear polyp on the left vocal cord is filled with fluid and flips inward when she breathes in and flips upward when she phonates.

smoker's polyps drawing inward during inspiration

This female smoker in her 50s has a very deep, male voice. She has a 25 pack-year history of smoking cigarettes. Smokers polyps frequently sit on top of the vocal cords during phonation, so that she can close them all away together, even though they vibrate at a deep pitch.

Vocal cords open

She has been a half pack a day smoker for 47 years. There is a white spot on the right side - leukoplakia. This sits on the smoker's polyp on the right side. Making sound, the polyp moves to the top of the vocal cord and is barely visible.

Bilateral large smoker's polyps

She has a 25 pack year history of smoking. She has bilateral, very large, smoker's polyps which are interfering with her breathing and her voice. She is almost always called "sir" on the telephone. On the left she is breathing out, and on the right she is breathing in.