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Vocal Polyps and Nodules - Causes, Symptoms, Diagnosis, and Treatment

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Vocal polyps and nodules are non-cancerous lesions involving the vocal cords or vocal folds. They are more commonly seen as compared to vocal cysts.

Written by

Dr. Ruchika Raj

Medically reviewed by

Dr. Akshay. B. K.

Published At September 22, 2022
Reviewed AtAugust 14, 2023

Introduction:

Vocal folds are the bands of soft tissue lamina which are present above the windpipe (trachea). These bands of vocal folds vibrate, and air from the lungs rushes through the throat from the mouth, producing the voice of the speech. Vocal folds also function for swallowing and respiration. Any abnormal growth on the vocal folds affects the ability to form a voice, swallow, and breathe.

What Are the Prevalence of Vocal Polyp and Vocal Nodules?

  • Vocal nodules are most common, ranging from one to three percent more than the vocal polyps, which account for 0.3 to 0.5% of total laryngeal lesions.

What Are Vocal Polyps?

Vocal polyps are the hypertrophic tissue growth (extra tissue) that may involve unilateral (most common) or bilateral vocal folds. Vocal fold polyps cause vocal fold paresis (vocal cord paralysis) if left untreated. Vocal polyps are soft lesions, highly vascularized, and appear as blisters.

What Are Vocal Nodules?

Vocal nodules are the solid bump-like growth that involves bilateral vocal folds mostly. It is also referred to as “singer’s nodes” or “screamers node” as it occurs due to overuse of voice (vocal abuse) like in singers and while screaming or yelling.

What Are the Causes of Vocal Polyps and Nodules?

  • Smoking.

  • Excessive consumption of caffeine and alcohol.

  • Allergies.

  • Acid reflux disease.

  • Vocal abuse (excessive use of vocal cords like screaming or yelling).

  • Infections involving the throat like sinusitis.

  • Direct trauma to the vocal folds during laryngeal surgery.

What Are the Signs and Symptoms of Vocal Nodules and Polyps?

  • Pain in swallowing.

  • Clearing throat repetitively.

  • A sensation of the presence of a foreign body in the throat.

  • Vocal fatigue.

  • Slurring of speech.

  • Pain or tenderness in the throat.

  • Sore throat.

  • Low-pitched voice.

  • Altered vocal tone or frequency.

  • Radiating pain from the throat into the ears.

  • Breathlessness while speaking.

  • Pain in the neck.

  • Hoarseness of voice.

  • Loss of voice.

  • Vocal paresis (vocal fold muscle paralysis seen in cases of vocal polyps).

  • Rough or scratchy voice.

How Can We Diagnose Vocal Cords and Polyps?

Various diagnostic criteria for vocal cord and polyps are :

  • History and Clinical Examination: Patients with a previous history of laryngeal surgery and trauma should be recorded. Complete clinical examination of vocal folds and voice alterations should be done.

  • Laryngoscopy: An apparatus with a light on the tip called a laryngoscope is used to expose the vocal folds and evaluate the presence of any abnormal growth. Any growth which tends to bleed on touching is diagnosed as vocal polyps as polyps are more vascularized and occur in the form of blisters. This is one of the differentiating features between the vocal fold polyps and vocal nodules, as vocal nodules are comparatively harder on clinical palpation and are mostly bilateral.

  • Videostroboscopy: A telescope-like apparatus with a video camera is used to analyze vocal cord movements while breathing and swallowing. Any defect in the opening and closing of the vocal folds can be detected.

  • Computed Tomography (CT) Scan of the Larynx: It is done to detect the presence of any abnormal growth in the vocal folds. The size and extent of the vocal lesions can be determined by the scan.

  • Voice Assessment: Voice assessment is done by the speech pathologist to check for the voice frequency, muscle tension of the vocal folds, and alteration in voice pitch.

  • Endoscopy: Fiberoptic endoscopy is one of the methods to diagnose the size and extent of lesions.

What Is the Treatment of Vocal Fold Nodules and Polyps?

Treatment modalities for vocal cord nodules and polyps are:

  • Conservative Management: Many vocal nodules resolve themselves on resting the voice, lifestyle modifications, and voice therapy in the vocal rehabilitation centers under the training of a speech pathologist.

  • Treatment of Underlying Causes: Underlying causes like acid reflux should be treated with antacids or proton pump inhibitors, antibiotics should be started in case of sinusitis, and antihistamines for allergies.

  • Steroid Therapy: Corticosteroid injections therapy is given to decrease the swelling or growth of the vocal folds. Small vocal polyps and nodules get resolved by steroid injection therapy.

  • Phonomicrosurgery: It is performed for larger size vocal fold nodules and polyps, which fail to resolve by conservative management. It is a surgical procedure that is done by using tiny sets of instruments. Instruments are inserted from the mouth into the throat, and a small cut is given to the vocal fold. The flap is then raised to expose the growth and is removed completely without damaging the adjacent tissues.

  • Endoscopic Laser Treatment: It is a widely used technique for the removal of vocal polyps, as polyps are more vascularized and tend to bleed easily. Lasers are used after exposing the vocal folds with a laryngoscope to shrink and remove the polyp. The advantage of laser over phonomicrosurgery is it does not cause much bleeding while removing polyps.

How Can We Prevent Vocal Cord Polyps and Nodules?

  • Lifestyle Modifications: Avoiding vocal overuse, reducing alcohol /caffeine consumption, and quitting smoking or tobacco products help in treating the vocal cord lesions.

  • Hydration Therapy: Drink plenty of fluids and keep yourself hydrated.

  • Check Up With the Doctor: Voice therapy and regular follow-up with an ENT specialist to prevent the recurrence of treated vocal cord lesions. Any underlying signs and symptoms like acid reflux disease, allergies, swallowing, and breathing difficulties should be reported to the doctor immediately.

Conclusion:

Lesions related to vocal cords are uncommon but can occur spontaneously in anyone. Although there are numerous treatment modalities currently, like speech therapies, behavioral modifications, laser techniques, and microsurgeries, early diagnosis, and management of vocal fold lesions are very crucial to prevent serious complications like breathing difficulties and speech problems. If left untreated, vocal fold nodules harden and form callus-like growth, while vocal fold polyps can result in vocal fold muscle paralysis. Regular follow-up with an ENT specialist for voice therapies after surgical treatment is important to prevent further recurrence of the laryngeal lesions.

Dr. Akshay. B. K.
Dr. Akshay. B. K.

Otolaryngology (E.N.T)

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vocal cord nodulesvocal folds swelling
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