International Journal of Phonosurgery & Laryngology

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VOLUME 13 , ISSUE 1 ( January-June, 2023 ) > List of Articles


The Three Vocal Fold Sign in Laryngology

Nupur K Nerurkar, Gati K Shah, Achala Kamath

Keywords : Granulomatous inflammation, Infraglottis, Laryngeal amyloidosis, Laryngeal cancer, Laryngopharyngeal reflux, Pseudosulcus, Subepithelial bulge

Citation Information : Nerurkar N K, Shah GK, Kamath A. The Three Vocal Fold Sign in Laryngology. Int J Phonosurg Laryngol 2023; 13 (1):14-15.

DOI: 10.5005/jp-journals-10023-1244

License: CC BY-NC 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


We are proposing a sign called, “three vocal fold sign” seen on laryngoscopy, which intends to help with the diagnosis of a few clinically challenging conditions like amyloidosis and other granulomatous conditions, laryngopharyngeal reflux, and laryngeal malignancy. This sign is defined as a uniform subepithelial bulge of the undersurface of the vocal folds. This bulge gives an impression of a third vocal fold, the first being the false vocal fold followed by the true vocal fold. A suspicion of amyloidosis or malignancy based on the proposed sign seen on laryngoscopy warrants a contrast-enhanced computed tomography (CT) scan. Any enhancement in the infraglottic region would suggest a possibility of a lesion warranting histopathological confirmation.

  1. Koufman JA. Gastroesophageal reflux and voice disorders. In: Rubin, Sataloff, Korovin, Gould, eds. Diagnosis and Treatment of Voice Disorders. New York-Tokyo: Igaku-Shoin Publishers, 1995:161–175.
  2. Jahnke, V. Bösartige tumoren des larynx. In Oto-Rhino-Laryngologie in Klinik und Praxis, Vol. 3. C. Herberhold (ed.). Stuttgart: Thieme, 1995:pp. 388–421.
  3. Sessions DG, Ogura JH, Fried MP. Carcinoma of the subglottic area. Laryngoscope 1975;85(10):1417–1423.
  4. Stell PM. The subglottic space. Can J Otolaryngol 1975;4(4):674–678. PMID: 1192286.
  5. Shaha AR, Shah JP. Carcinoma of the subglottic larynx. Am J Surg 1982;144(4):456–458. DOI: 10.1016/0002-9610(82)90422-6
  6. Laramore GE. Larynx. In: Laramore GE (ed) Radiation therapy of head and neck cancer. Springer, Berlin Heidelberg New York, 1989:pp. 125–143.
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