Vocal Cord Nodules And Polyps

Nodules on the vocal cord result from hypertrophy of fibrous tissue and form at the point where the cords come together forcibly. Vocal cord polyps are swellings on the true vocal cord caused by edema in the lamina propria of the mucous membrane. Nodules and polyps have good prognoses, unless continued voice abuse causes recurrence, with subsequent scarring and permanent hoarseness.

Causes

Vocal cord nodules and polyps usually result from voice abuse, especially in the presence of infection. Voice abuse results from speaking consistently at the wrong pitch or for a long duration, and using too loud a voice. Many vocal abusers combine all three practices. Consequently, vocal cord nodules and polyps are seen most commonly in teachers, singers, and sports fans, and in energetic children (ages 8 to 12) who continually shout while playing. Polyps are common in adults who smoke, live in dry climates, or have allergies.

Signs and symptoms

Polyps can make the voice become breathy-sounding and harsh. The person may complain of hoarseness.The voice may also develop a breathy or husky quality.

Diagnosis

The head and neck surgeon (otorhinolaryngologist) must see the vocal cords to diagnose these lesions. It is also important to confirm that there are not other problems instead of or in addition to these benign lumps. Other causes of hoarseness include throat cancers, vocal cord paralysis , and simple laryngitis . The cords can usually be seen using a mirror placed at the back of the tongue. More elaborate scopes, including a videostroboscope, allow better views while the cords are producing sounds.

A biopsy of a nodule or polyp will ensure they are not cancerous.

Treatment

Conservative management of small vocal cord nodules and polyps includes humidification, speech therapy (voice rest, training to reduce the intensity and duration of voice production), and treatment of any underlying allergies.

When conservative treatment fails to relieve hoarseness, nodules or polyps require removal under direct laryngoscopy. Microlaryngoscopy may be done for small lesions to avoid injuring the vocal cord surface.

If nodules or polyps are bilateral, excision may be performed in two stages: one cord is allowed to heal before the polyps on the other cord are excised. Two-stage excision prevents laryngeal web, which occurs when epithelial tissue is removed from adjacent cord surfaces and these surfaces grow together.

For children, treatment consists of speech therapy. If possible, surgery should be delayed until the child is old enough to benefit from voice training, or until he can understand the need to abstain from voice abuse.

Prevention

Good preventive practices include:

Properly using the voice to eliminate strain
Avoiding screaming and loud talking
Speaking in a normal range that is comfortable
Not whispering or speaking at a higher or lower pitch than is natural
Releasing neck tension by gently tipping the head forward and to each side while keeping the shoulders down.

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