Finally, the patient was instructed to phonate at a low pitch, causing a left physiological sulcus containing a vocal fold hemorrhage to be delivered superiorly by the mucosal wave
Videostroboscopic findings suggestive of presbyphonia include vocal fold bowing, prominent vocal processes, a spindle-shaped glottic chink, and reduction in amplitude of the mucosal wave
Sustained trends for improvement are supported by data for mucosal wave
grade assessment, voice handicap index (VHI), and voice quality questionnaire.
Similar disruption of the layered structure and mucosal wave
function also may occur congenitally, as in some cases of sulcus vocalis.
Findings on videostroboscopy may include decreased mucosal wave
, vocal fold scarring disproportionate to the visible lesion, vibratory margin irregularities, and bilaterality of abnormalities in the face of a unilateral lesion.
Dysphonia generally ensues because of vocal fold stiffness leading to improper propagation of the mucosal wave
Both vocal folds featured a large mucosal wave
that was consistent with the observed background edema, although the mucosal wave
of the right vocal fold was less than that of the left vocal fold at the site of the intracordal lesion.
The left vocal fold mass effect made it impossible to judge the right mucosal wave
, which might not have been as impaired as it appeared to be.
Six months postoperatively, stroboscopy demonstrated a return of robust mucosal wave
without any subsequent hemorrhage.
The right true vocal fold was irregular with decreased mobility and mucosal wave
, and the left true vocal fold was similarly irregular with decreased mobility but no mucosal wave
The mucosal wave
and amplitude of the right true vocal fold were severely reduced.
Limitation of the mucosal wave
may be associated with infection and inflammation (including that caused by reflux), but it should improve with treatment.