A patient presents with sudden onset of voice loss and uses writing to convey that they could not phonate above a whisper after cheering at a football game. Which diagnosis is most likely?

• A. Vocal fold polyp
• B. Vocal fold hemorrhage
• C. Granuloma
• D. Sulcus vocalis

Answer: (B)

When a person suddenly loses their voice after yelling, think of acute vocal fold trauma causing a hemorrhage. A burst blood vessel on the surface of the vocal fold creates a hematoma, thickening and stiffening the fold so it can’t vibrate normally. That disruption often leaves the voice sounding severely reduced or completely aphonic, sometimes only allowing a whisper.

This fits the scenario of suddenly losing voice after cheering, rather than a gradual change. Other issues like a vocal fold polyp tend to develop over time with ongoing misuse and usually produce a more gradual hoarseness; granuloma is often linked to previous intubation or reflux and presents with symptoms like throat clearing and globus sensation rather than an abrupt loss of voice; sulcus vocalis is a groove in the vocal fold that causes chronic breathy hoarseness, not an acute post-chant event.