Polyps of vocal cords

by Dr. Christopher Chang, last modified on 10/29/17
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Vocal cord cysts and polyps are painless “bumps” that develop on the vocal cords causing symptoms of a slowly progressive raspy voice. Initially, the raspiness may only occur in the high pitches characterized by onset delays (voice that starts silent before a sound is produced) or pitch breaks (certain sounds that disappear). However, as they get bigger, the raspiness may extend to throughout the entire vocal pitch range. Listen to some examples of patients with vocal cord cysts and polyps here.

Vocal cord cysts and polyps are not cancerous and are known to be exacerbated by excessive voice use (singing, cheerleading, teachers, yelling, screaming, etc). Less commonly, they can occur due to other abusive vocal behaviors including chronic throat clearing, chronic coughing, and whispering.

However, what causes them to occur in the first place is less clear. Cysts are vocal cord masses located UNDERNEATH the lining of the vocal cord whereas polyps are masses INVOLVING the lining of the vocal cord. To use an analogy, cysts are much like sebaceous cysts that can be found under the facial or neck skin whereas polyps are like blisters of the skin like those that form on the hand when shoveling a lot of dirt or rowing a boat. A similar but different condition called vocal cord nodules is due to a “callous” formation on the vocal cord lining, much like shoveling dirt will eventually lead to callous formation on the hands.

Vocal cord cysts and polyps can develop almost anywhere on the vocal cord. Before going into how they form, let’s take a look at the diagram below depicting what NORMAL vocal cords looks like:

In the picture, the thin white blades are the true vocal cords. When they move apart, air can move in between the vocal cords into the lungs allowing a person to breathe. When they come together with talking or singing, they vibrate creating the voice. Watch a video to see how a normal voicebox works.

The take-home point here is that the vocal cords come together to create a voice. As such when the voice is abused (screaming, yelling, or just plain talking too much), the vocal cords aggressively vibrate against each other resulting in irritation ESPECIALLY to any mass present on the vocal cord. Such repetitive vibratory trauma to a cyst or polyp will cause them to swell and get bigger causing the voice to degrade in quality. That’s why a patient may note their voice is best in the morning and gets progressively worse the more they talk during the day. With voice rest, the cyst/polyp gets smaller and the vocal quality improves.

There are several theories as to why a cyst or polyp may form on the vocal cord in the first place. My personal favorite theory is as follows. At some point, an acute traumatic event to the vocal cord occurs stemming from a yell, cough, or laryngitis. Depending on what happens next determines whether a polyp or cyst develops.

With a cyst, the mucosal vocal cord lining breaks down and during the healing process a cyst develops due to entrapped cells meant for creating lining. A polyp, however, is in essence a blistering of the lining. Vocal cord nodule for comparison’s sake is just callous thickening of the vocal cord lining.

Vocal Cord Polyp

Vocal Cord Cyst

Smoker’s Polyps

In one extreme vocal cord polyp situation, Smoker’s Polyps can develop whereby nearly the entire vocal cord is polypoid. This unique situation is due to smoking AND excessive talking. It is the combination of the two which leads to Smoker’s polyps.

DID YOU KNOW?
Grammy-award winning singer, Adele, suffered from vocal cord polyp as well as singer Keith Urban.

Treatment

Traditional standard of care management of vocal cord cysts and polyps start with voice therapy and avoidance of any activities leading to voice abuse (screaming, yelling, etc). The main reason is that with voice therapy alone, it is not uncommon that the cyst or polyp may resolve to point where the vocal quality becomes acceptable and stable. However, more often, only mild improvement occurs with persistence of hoarseness. At this point, surgical excision is recommended. Watch video.

In the case of Smoker’s Polyps, quitting smoking is also essential.

With a cyst, the lining is incised and the cyst removed (micro-flap approach shown in the picture). However, with a polyp, it is simply grabbed and removed at its base. Typically no sutures are used to close the incision after excision, mainly because sutures tend to promote scar formation that can adversely affect the voice.

After surgery, STRICT voice rest is mandatory to allow the body to heal the surgical wound site. After about 1-2 weeks, the patient is allowed to start talking in small increments under the guidance of a voice therapist until complete healing has occurred in about 4 weeks. However, the vocal cord lining is “brand new” and careful voice use is recommended for at least 6 months (absolutely no screaming, yelling, or excessive voice use) which risks mucosal tearing and recurrence. Eventually, the patient may use their voice without restriction.

Both for 1 week before and up to 3 months after surgery, reflux medications are recommended for reflux prophylaxis. Why? Because if there’s ANY acid that washes over the surgical site from a reflux event, healing will not occur properly (imagine putting some acid drops into the eye after eye surgery).

As a reminder, though vocal cord cysts and polyps can be removed with surgical excision, they can recur if underlying abusive voice behavior that led to the initial formation is not addressed.

If you are suffering from vocal cord cysts or polyps, please contact our office for an appointment.

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Any information provided on this website should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment. Advertisements present are clearly labelled and in no way support the website or influence the contents.

www.fauquierent.net

The term vocal cord lesion (physicians call them vocal “fold” lesions) refers to a group of noncancerous (benign), abnormal growths (lesions) within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems and are generally seen in three forms; nodules, polyps, and cysts.

Vocal Cord Nodules (also called Singer’s Nodes, Screamer’s Nodes)

Vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped.

Vocal Cord Polyp

 A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances.

Vocal Cord Cyst

A vocal cord cyst is a firm mass of tissue contained within a membrane (sac). The cyst can be located near the surface of the vocal cord or deeper, near the ligament of the vocal cord.  As with vocal cord polyps and nodules, the size and location of vocal cord cysts affect the degree of disruption of vocal cord vibration and subsequently the severity of hoarseness or other voice problem. Surgery followed by voice therapy is the most commonly recommended treatment for vocal cord cysts that significantly alter and/or limit voice.

Reactive Vocal Cord Lesion

A reactive vocal cord lesion is a mass located opposite an existing vocal cord lesion, such as a vocal cord cyst or polyp. This type of lesion is thought to develop from trauma or repeated injury caused by the lesion on the opposite vocal cord. A reactive vocal cord lesion will usually decrease or disappear with voice rest and therapy.

What Are The Causes 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.

What Are The Symptoms Of Benign Vocal Cord Lesions?

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 Is The Diagnosis Of A Benign Vocal Cord Lesion Made?

Diagnosis begins with a complete history of the voice problem and an evaluation of speaking method. The otolaryngologist will perform a careful examination of the vocal cords, typically using rigid laryngoscopy with a stroboscopic light source. In this procedure, a telescope-tube is passed through the patient’s mouth that allows the examiner to view the voice box (images are often recorded on video). The stroboscopic light source allows the examiner to assess vocal fold vibration. Sometimes a second exam will follow a trial of voice rest to allow the otolaryngologist an opportunity to assess changes in the vocal cord lesion. Other associated medical problems can contribute to voice problems, such as: reflux, allergies, medication’s side effects, and hormonal imbalances. An evaluation of these conditions is an important diagnostic factor.

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.

www.entnet.org
By Sally Robertson, BSc

The vocal cords are two thin and flexible bands of muscle tissue which run from front to back inside the larynx, just above the opening of the trachea. Lesions of the vocal cords are one of the most common causes of voice disorders.

Vocal cord lesions are benign, abnormal growths that are generally categorized into three types: nodules, polyps and cysts. These lesions are more common in those who use their voice as part of their occupation, such as salesmen, cheerleaders or singers.

Vocal cord lesions can arise as a result of the voice being used too aggressively or too much. Screaming, shouting or trying to talk when one is hoarse, for example, are all factors that may contribute to the problem. Smoking, alcohol use, and allergies may worsen the condition.

Types of vocal cord lesion

Vocal cord nodules

Also referred to as Screamer’s Nodes or Singer’s Nodes, these nodules typically develop on both sides of the vocal folds, usually at the midpoint. Under a microscope, these growths resemble calluses. They are sometimes associated with abnormal vasculature. They are thought to be caused by overuse or misuse of the voice and tend to disappear once this trigger is removed. Both men and women may develop these growths, although they are more common in women in the age group between 20 and 50 years.

Vocal cord polyps

A vocal cord polyp usually appears on only one vocal cord, although in some patients they can develop on both cords. They occur in different shapes and sizes, but tend to be larger than nodules. They look a bit like blisters. Their effects on the voice are wide-ranging, depending on the type of polyp. Compared to nodules, polyps tend to have more blood vessels and are therefore a reddish color. Polyps are also caused by overuse or misuse of the voice such as singing, screaming, shouting or excessive talking. A different type of vocal cord polyp called Reinke’s edema or polypoid corditis is caused almost entirely by smoking.

Vocal cord cysts

A vocal cord cyst is a firm mass of tissue, contained within a membrane, and it may be located near the surface of a vocal cord or deeper, close to the vocal cord ligament. The extent to which it affects the voice depends on the size and location of the polyp. These cysts are less common than the nodules or polyps described above. These cysts are categorized into two types: epidermoid cysts and mucus retention cysts. They may be caused by strained use of the voice, for example, trying to converse as normal during a bout of laryngitis or an infection of the upper respiratory tract. Usually, surgery and voice therapy is recommended for cases where the cyst is causing significant voice disruption.

Symptoms of vocal cord lesions

Most vocal cord lesions manifest as:

  • Hoarseness
  • Vocal fatigue
  • Raspy voice
  • Loss of pitch
  • Unpredictable breaking of the voice
  • Frequent need to clear the throat

Reviewed by Dr Liji Thomas, MD.

References

  • http://www.uofmhealth.org/conditions-treatments/vocal-fold-lesions-nodules-cysts-and-polyps
  • https://my.clevelandclinic.org/services/head-neck/diseases-conditions/hic-vocal-cord-lesions
  • http://www.entnet.org/content/nodules-polyps-and-cysts

Further Reading

  • What are Vocal Cords?
  • Vocal Cord / Fold Development
  • Vocal Cord Wounds
  • Vocal Cord Surgery
  • Vocal Cord Lesion Treatment

www.news-medical.net

Polyps in vocal cords, vocal cord benign growths that occur in. More is seen between the ages of 20-50. It is more common in women than men. An abuse of the vocal cords, swelling of the vocal cords that occur on can be described as soft. Soft polyps of the vocal cords also occur if the misuse continues for a long time that child may become permanent. Polyps of the vocal cords in one, or both may indicate the occurrence. That looks like a piece of meat polyps are larger than nodules formations. 

What are the symptoms of polyps in vocal cords?

  • Hoarseness

  • The lack of sound

  • Crackling sound

  • Thickening sound

  • Muffled sound

  • Feeling of lump in the throat

  • Neck pain

  • Ear pain

  • Sometimes the body and voice fatigue

  • What causes polyps on his vocal chords?

A polyp on your vocal cords, usually occurs because of Bad use of the sound. A traumatic event can lead to polyps but also audio. In addition, the audio there are many factors that can cause polyps.

What are the causes of polyps in vocal cords?

  • Smoking

  • Nov tension

  • Allergy

  • Some professional groups

  • Don’t get loud

  • Excessive caffeine and alcohol consumption

  • Stress

  • Infectious diseases long

What is the treatment for polyps on his vocal cords?

A polyp on your vocal cords, drug therapy, surgery, or behavioral therapy can be treated with certain methods. Surgery polyps can be removed. If the polyps are very large and if you have been around a long time, usually can be treated with surgery. However, in rare cases in children with vocal cord polyps surgery are applied. Usually is tried to be with other treatment options for the treatment of polyps.

The Causes Of Polyps In Vocal Cords

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