Large laryngeal polyp causing airway obstruction

A 62-year-old woman smoker presented with 1 week of common cold and worsening hoarseness. She presented with dyspnea, which had been worsening over the past few days. On the initial examination in the emergency room, she could not lie down, stridor was evident and fiberoptic laryngoscopy revealed large laryngeal mass causing airway obstruction. Large laryngeal mass disappeared in subglottis with inspiration (Fig. 1a) and appeared in supraglottis with expiration (Fig. 1b). She had a normal white cell count (7.5 × 103/μl; normal 4.0？9.0 × 103/μl) and a raised C-reactive protein (0.55 mg/dl; normal 0.00–0.30 mg/dl). Because intubation was judged impossible, an emergency tracheotomy was performed under local anesthesia. Subsequent direct laryngoscopy under general anesthesia identified a valve-like large laryngeal mass attached to the right vocal cord. I removed it by a pair of microscissors. Pathological diagnosis was laryngeal polyp. The patient recovered well and was discharged after 2 weeks. Although she had no recurrence and was uneventful during the 1-year follow-up, I have been telling her strongly not to smoke