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A 51-year-old female social worker presents with complaints of hoarseness and persistent cough. Her cough had been persistent since childhood and fluctuated throughout the year. She had been seen by many physicians including other otolaryngologists and pulmonologists. She had been diagnosed with multiple environmental allergies, allergic rhinitis, postnasal drip, bronchitis, gastroesophageal reflux, and asthma. Previous treatment with voice rest, steroids, antibiotics, inhalers, antihistamines, and nasal sprays had produced no improvement. Bronchoscopy, pulmonary function testing, and chest X-ray were all within normal limits. She had a distant 7 pack year smoking history and quit over 20 years prior to our evaluation. Strobovideolaryngoscopy at her initial visit (see Figure 1) showed a left vocal fold hemorrhage which approached but did not involve the vocal fold edge, right Reinke edema, evidence of prior …