ANTERIOR COMMISSURE MICROWEBS ASSOCIATED WITH VOCAL NODULES - DETECTION, PREVALENCE, AND SIGNIFICANCE

Vocal fold nodules are a common cause of dysphonia generally attribute d to vocal abuse. Anterior commissure microwebs have been reported as an incidental finding in surgical patients with nodules. In a series o f 105 nodule patients evaluated at the University of Wisconsin Clinica l Science Center voice laboratory (1987-1992), 11 microwebs were ident ified. Ten of these microweb patients were among the 20 nodule patient s who did not respond to voice therapy and underwent microsurgery. In patients with nodules whose hoarseness is refractory to voice therapy, symptoms that occur early in life suggest the presence of occult voca l fold pathology. Microweb detection requires a high index of suspicio n, observation during maximal vocal fold abduction, and clearance of s ecretions from the anterior commissure. Definitive identification is f acilitated by gentle separation of the anterior vocal folds during dir ect microlaryngoscopy. The presence of these tiny shelves of tissue mi ght be coincidental, or they might represent, another expression of th e tissue response to traumatic factors known to produce vocal nodules. We found little difference in vocal function parameters between two s imilar groups of nodule patients, one with and one without associated microwebs. Further work is needed to determine the significance of mic rowebs.