Vocal cord nodules and polyps are noncancerous growths on the vocal cords that affect the voice.The vocal cords (also called vocal folds) are two bands of smooth muscle tissue located in the larynx (voice box). The larynx is located in the neck at the top of the trachea (windpipe). Vocal cords produce the sound of your voice, by vibration and the air passing through the cords from the lungs. The sound the vocal cords produce is then sent through the throat, nose, and mouth, giving the sound “resonance.” The sound of each individual voice is determined by the size and shape of the vocal cords and the size and shape of the throat, nose, and mouth (the resonating cavities).

Vocal cord disorders are often caused by vocal abuse or misuse, such as excessive use of the voice when singing, talking, smoking, coughing, yelling, or inhaling irritants. Some of the more common vocal cord disorders include laryngitis, vocal nodules, and vocal polyps.

Vocal nodules: are benign (non-cancerous) growths on the vocal cords caused by vocal abuse. Vocal nodules are a frequent problem for professional singers. The nodules are small and callous-like and usually grow in pairs (one on each cord). The nodules usually form on areas of the vocal cords that receive the most pressure when the cords come together and vibrate (similar to the formation of a callous). Voice nodules cause the voice to be hoarse, low, and breathy.

Vocal polyps: is a soft, benign (non-cancerous) growth, similar to a blister. A polyp usually grows alone on one vocal cord and is often caused by long-term cigarette smoking. Other causes of vocal polyps include hypothyroidism (underactive thyroid gland), gastroesophageal reflux, and continuous voice misuse. Voice polyps cause the voice to be hoarse, low, and breathy. Vocal polyps are also called Reinke’s edemas or polypoid degeneration.

How are vocal cord disorders diagnosed?

Any hoarseness or change in voice that lasts longer than two weeks should be brought to the attention of your physician. (Sometimes the hoarseness may be indicative of laryngeal cancer.) In addition to a complete medical history and physical examination, the physician may examine the vocal cords internally with a small, long-handled mirror (a procedure called indirect laryngoscopy in which the mirror is inserted into the throat so parts of the larynx can be examined) or with a lighted tube (a procedure called direct laryngoscopy in which an instrument called a laryngoscope is inserted through the nose or mouth. The scope is lighted to provide a better view of the area than the indirect laryngoscopy.).

What are the causes and symptoms of benign Vocal Cord Lesions?

The exact cause or causes of benign vocal cord lesions is not known. Lesions are thought to arise following “heavy” or traumatic use of the voice, including voice misuse such as speaking in an improper pitch, speaking excessively, screaming or yelling, or using the voice excessively while sick.

A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion. Other symptoms can include:

  • Vocal fatigue
  • Unreliable voice
  • Delayed voice initiation
  • Low, gravelly voice
  • Low pitch
  • Voice breaks in first passages of sentences
  • Airy or breathy voice
  • Inability to sing in high, soft voice
  • Increased effort to speak or sing
  • Hoarse and rough voice quality
  • Frequent throat clearing
  • Extra force needed for voice
  • Voice “hard to find”

When a vocal cord lesion is present, symptoms may increase or decrease in degree, but will persist and do not go away on their own.

How are benign Vocal Cord Lesions Treated?

The most common treatment options for benign vocal cord lesions include: voice rest, voice therapy, singing voice therapy, and phonomicrosurgery, a type of surgery involving the use of microsurgical techniques and instruments to treat abnormalities on the vocal cord.

Treatment options can vary according to the degree of voice limitation and the exact voice demands of the patient. For example, if a professional singer develops benign vocal cord lesions and undergoes voice therapy, which improves speaking but not singing voice, then surgery might be considered to restore singing voice. Successful and appropriate treatment is highly individual and includes consideration of the patient’s vocal needs and the clinical judgment of the otolaryngologist.

Correction of the underlying cause cures most nodules and prevents recurrence. Removal of the offending irritants allows healing, and voice therapy with a speech therapist reduces the trauma to the vocal cords from improper singing or protracted loud speaking. Nodules usually regress with voice therapy alone.

Most polyps must be surgically removed to restore a normal voice. Cold-knife microsurgical excision during direct microlaryngoscopy is preferable to laser excision, which is more likely to cause collateral thermal injury if improperly applied.

In microlaryngoscopy, an operating microscope is used to examine, biopsy, and operate on the larynx. Images can be recorded on video as well. The patient is anesthetized, and the airway is secured by high-pressure jet ventilation through the laryngoscope, endotracheal intubation, or, for an inadequate upper airway, tracheotomy. Because the microscope allows observation with magnification, tissue can be removed precisely and accurately, minimizing damage (possibly permanent) to the vocal mechanism. Laser surgery can be performed through the optical system of the microscope to allow for precise cuts. Microlaryngoscopy is preferred for almost all laryngeal biopsies, for procedures involving benign tumors, and for many forms of phonosurgery.

Sources: Health Care, Entusa

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