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Management of Vocal Fold Polyps, Cysts, and Nodules

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Vocal fold polyps, cysts, and nodules are noncancerous growths in the vocal cords, affecting their ability to vibrate and produce sound.

Written by

Dr. Osheen Kour

Medically reviewed by

Dr. Akshay. B. K.

Published At March 31, 2023
Reviewed AtAugust 14, 2023

What Are Vocal Fold Polyps, Cysts, and Nodules?

Vocal Fold Polyps: These can appear on one or both sides of the vocal cords are vascularized (have blood vessels), and appear reddish. The vocal fold polyps look like blisters and can be in varying shapes and sizes. These polyps mainly occur due to overuse and misuse of the voice, especially due to sudden yelling or vocal abuse. Vocal fold polyps cause various traumas, such as screaming, singing, excessive talking, and cheerleading.

In addition, these voice problems may occur due to extra muscle tension while smoking, speaking, allergies, alcohol use, and sinusitis. Reinke’s edema or polypoid corditis is a type of vocal cord polyp usually appearing due to smoking and sometimes with hypothyroidism.

Vocal Fold Cysts: These are vocal cord lesions with a semisolid center or a fluid-filled sac around them. Vocal fold cysts are rare and mainly are of two types, sebaceous or epidermoid cysts, and mucus retention cysts. These lesions do not occur due to overuse or misuse of the voice, like vocal cord polyps and nodules.

Vocal Fold Nodules: These are caused due to the repetitive and frequent overuse and misuse of the voice, thus causing vocal cord trauma. These nodules in the vocal cord are often called nodes or singer’s nodules. Vocal fold nodules are callous-like growths in the center of the vocal folds. They are sometimes associated with abnormal blood vessels as they appear callous-like under the microscope. Vocal fold nodules can affect both males and females, but women are more prone to develop this condition between the age of 20 to 50 years.

What Are the Causes of Vocal Fold Polyps, Cysts, and Nodules?

Vocal fold cysts, polyps, and nodules are mainly caused due to frequent trauma to the vocal folds due to constant taking, yelling, screaming, and misuse of the voice. Nodules and polyps in the vocal folds can occur due to irritants in the cigarette and stomach acid reflux into the larynx. On the other hand, vocal fold cysts usually appear due to mucus gland blockage under the tumors of the vocal cords and thus cause voice problems. These vocal cord tumors mainly occur due to alcohol abuse and smoking.

What Are the Symptoms of Vocal Fold Polyps, Cysts, and Nodules?

The symptoms of vocal cord lesions include:

  • Hoarse voice.

  • Breathy or airy voice.

  • Frequent throat clearing.

  • Vocal fatigue.

  • Difficulty in singing high-pitched notes.

  • Low-pitched voice.

  • Increased efforts to sing or speak.

  • Shooting ear-to-ear pain.

  • Coughing.

Who Is at a Risk of Developing Vocal Cord Problems?

Vocal cord problems usually appear in people to speak a lot or overuse their voice. Nodules usually appear in these people. They include

  • Radio hosts.

  • Singers.

  • Cheerleaders.

  • Teachers.

  • Preachers.

  • Salesperson.

  • Coaches.

How Are Vocal Fold Polyps, Cysts, and Nodules Diagnosed?

A person experiencing the symptoms of vocal cord lesions, such as voice hoarseness that may persist for more than one or two weeks, should consult the ENT (ear, nose, and throat doctor), also known as an otolaryngologist, for an initial examination and diagnosis. In addition, a laryngologist's exact diagnosis of the vocal cord defect is made with the help of a laryngoscopy using a stroboscope or video stroboscope. This is a special light to examine the vibrations of the vocal cord. The doctor also examines the head and neck of the patient and thus evaluates the case. Depending on the patient's initial examination, he may suggest further testing for voice (acoustic) analysis.

What Is the Management of Vocal Fold Polyps, Cysts, and Nodules?

Diagnosing vocal fold polyps, cysts, and nodules is crucial in managing vocal cord lesions. Various treatment options are available to manage these conditions, including conservative behavioral, dietary, medical, and surgical interventions. The doctor mainly advises behavioral voice therapy for vocal cord nodules, and surgical interventions are recommended if the refractory lesions are present and voice therapy alone is not very effective. On the other hand, vocal cord lesions like cysts and polyps cannot be managed with voice therapy, and therefore the surgical approach is needed in such cases.

The treatment of vocal fold polyps, cysts, and nodules include

  • Voice Therapy: This treatment method heals the vocal cord injury and helps prevent future trauma. Voice therapy is conducted by a professional speech pathologist who engages people in various vocal exercises to reduce throat strain, improve breathing, and obtain maximum frequency, pitch, and resonance for healthy and strong speaking. Voice therapy plays an important role in the voice recovery of the patient to improve voice quality.

  • Vocal Cord Laser Surgery: Some vocal cord lesions need to be removed. The doctor uses a thin scope to perform the procedure under general anesthesia. This device is inserted in the patient’s nose to shrink the vocal cord lesion with laser beams. After the procedure, the patient is advised to take voice therapy and voice rest.

  • Microsurgery: These surgeries are recommended for various non-cancerous lesions of the vocal cord, such as polyps, cysts, and nodules. The procedure is also known as phonomicrosurgery. The surgeon inserts the small surgical instrument in the patient's throat via mouth under general anesthesia. The lesion growth is removed by making a small incision away from the vibrating edge of the vocal cord by raising a thin flap of non-cancerous tissue growth. This surgical method minimizes the risk of scarring and provides the best voice quality. For optimal recovery, the doctor recommends voice therapy after microsurgery.

  • Medical Management: Various medical problems causing voice disorders, such as acid reflux, chronic cough, and allergies, are also treated with medications.

How to Prevent Vocal Cord Lesions?

Vocal cord lesions can be prevented in the following ways:

  • Avoiding smoking and alcohol.

  • Getting proper treatment for allergies, sinusitis, hypothyroidism, or acid reflux.

  • Warming up the voice before prolonged speaking and singing.

  • Reduce muscle tension by indulging in yoga, relaxation techniques, and cognitive therapy.

  • A person should refrain from excessive and frequent taking without adequate voice rest.

  • A person should use a microphone.

  • Drinking plenty of water and avoiding excess caffeine intake.

  • Avoid excessive talking and slinging if a person has an upper respiratory infection.

Conclusion

Vocal fold lesions are mainly associated with vocal trauma and voice overuse in people who talk excessively while taking voice rest. The condition can also occur due to various underlying medical conditions like sinusitis, allergies, etc. Therefore, a comprehensive treatment is used to manage vocal fold polyps, cysts, and nodules. Though these lesions are non-cancerous, they may impair speech and affect a person's breathing if left untreated. In some cases, larynx cancer may also develop in the vocal cords due to changes in voice and hoarseness. Therefore, a person experiencing any symptoms of vocal fold lesions (cysts, polyps, and nodules) should immediately consult the doctor for early diagnosis and treatment.

Frequently Asked Questions

1.

Where Do Vocal Cord Polyps Occur Most Frequently?

 
Vocal cord nodules, often known as singer's or screamer's nodes, can develop if the voice is misused or overused regularly. The vocal cords' midpoint experiences the development of these callus-like growths. It is the area where speaking, the portion of the vocal cords, is most frequently employed.

2.

To Which Two Structures of the Larynx Are the Vocal Folds Attached?

 
The glottic space is made up of the voice cords, the glottis, and the larynx ventricles. The vocal cords are made up of four folds of fibroblastic tissue, two on top and two on bottom. The top folds are attached to the thyroid cartilage, and the bottom folds are attached to the arytenoid cartilage.

3.

Which Specific Laryngeal Joint Is Responsible for the Process of Vocal Fold Elongation?

 
The cricothyroid glands are a pair of endocrine glands located in the neck region that are responsible for the lengthening of the vocal folds. They achieve this by pulling the cartilage of the thyroid downward and forward on its hinge, thereby increasing the distance from the arytenoids or the thyroid notch (also known as the Adam's Apple). This, in turn, lengthens and tightens the vocal folds, which in turn causes the vocal folds to vibrate more quickly, which in turn raises the pitch.

4.

What Is the Process by Which Vocal Polyps Are Formed?

 
Nodules are generally caused by vocal abuse or misconduct. Polyps can be caused by chronic vocal abuse. However, polyps can develop after a single incident of vocal abuse, such as shouting at a concert. Polyps can also be caused by long-term cigarette smoking, thyroid issues, and reflux.

5.

What Is the Primary Etiology of Vocal Cord Polyps?

 
These growths are most commonly brought on by excessive use of one's voice, which can take the form of talking too loudly or too much. However, they can also be brought on by persistent coughing, acid reflux, or allergies.

6.

What Is the Influence of Vocal Fold Nodules?

Hoarseness, raspy or breathy quality to the voice, and even breathiness are common symptoms of vocal nodules. People who suffer from vocal nodules often find that they are unable to sustain a note for as long as they formerly could. They are unable to sing in very high or very low notes, nor are they able to speak in a very high or very low voice.

7.

What Is the Effect of Vocal Fold Vibration?

Air is expelled from the lungs, travels down the trachea, and then enters the larynx. The vibration of the vocal folds is caused by the air. When a person speaks, their vocal folds vibrate, which causes them to alternately trap and release air.

8.

What Is the Impact of Stiffness on Vocal Fold Vibration?

Changes in the stiffness of the vocal folds also have a significant influence on the phonation threshold pressure, as well as the glottal area and flow rate. An increase in vocal fold stiffness has the effect of decreasing the means and amplitudes of both the glottal area and flow rate.

9.

What Are Polyps and Nodules of the Vocal Folds?

Calluses are one type of noncancerous growth that can occur on vocal cords. Vocal cord nodules, vocal cord cysts, and vocal cord polyps are also other types. They have the potential to make the voice sound gruff, hoarse, or even breathy. Because of the bumps, the vocal cords will cease to be able to vibrate regularly, which could cause the voice to crack or stutter.

10.

Do Vocal Nodules and Polyps Have Identical Characteristics?

 
Repetitive phonotrauma, often known as overuse or incorrect use of the voice chords, is the cause of nodules. Polyps are a consequence of repeated phonotrauma, but they are also able to develop as a direct result of a single incident. Cysts form on the vocal cords when the glands that produce mucus become obstructed; in some cases, this condition is the result of repeated phonotrauma.

11.

What Exactly Are Symmetrical Voice Nodules on Both Sides?

 
Vocal cord nodules are growths that originate on the vocal cords and are sometimes referred to as "vocal fold" nodules by medical professionals. These lumps are completely harmless and noncancerous, and they look very much like the calluses that can develop on one's hands. Nodules are a prevalent source of voice problems in people of all ages, including children and adults, and they can affect both girls and boys.
Source Article IclonSourcesSource Article Arrow
Dr. Akshay. B. K.
Dr. Akshay. B. K.

Otolaryngology (E.N.T)

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