A 68-year-old man, a retired counselor, had a “raspy” voice throughout his entire life. He reported hoarseness, difficulty speaking loudly, and vocal fatigue. His vocal handicap index (VHI) was 53.
Strobovideolaryngoscopy revealed bilateral sulcus vocalis (figure 1). This congenital lesion results in deficiency or absence of the superficial layer of the lamina propria. Figure 2 shows an ellipsoidal area along the left vocal fold where there is only a thin layer of epithelium over the vocal ligament.