About Vocal Cord Nodules, Cysts, and Polyps
Vocal cord nodules, vocal cord cysts, and vocal cord polyps are noncancerous growths or bumps. These lesions are like calluses on your vocal cords in that they develop over time due to how the vocal cords contact each other with voice use. The bumps often get in the way of the vocal cords closing completely, allowing air to escape during voicing. This can result in a voice that is rough, breathy, or raspy. Your voice may crack or cut in and out as the bumps also prevent your vocal cords from vibrating normally. Often, the throat ends up straining more than necessary, resulting in a voice that can worsen the more you use it or gets very tired by the end of the day (this is called muscle tension dysphonia).
High voice use, talking too loudly, or talking too much is frequently the cause of these growths. If your profession demands you speak constantly and with a loud voice -- like teachers, clergy members, lawyers, and salespeople -- you are at greater risk for developing vocal cord nodules, cysts, or polyps. Singers are also at higher risk because of their vocal demands. Left untreated, the growths can lead to voice strain as your body attempts to compensate for your injury.
Noncancerous vocal cord lesions can also result from trauma caused by chronic coughing or throat clearing. Some medical factors like acid reflux, sleep apnea, and allergies can further aggravate your throat and voice box.
Treatments for Vocal Cord Nodules, Cysts, and Polyps
Voice therapy can teach you how to use your voice more efficiently and without strain so your injury can heal. In some cases, surgery is needed to remove the growths. After surgery, voice therapy is essential to rehabilitate your voice and ensure your best vocal recovery.
Voice therapy helps your vocal cords heal and helps you avoid future injury. Our speech pathologists guide you through vocal exercises to improve breathing, reduce throat strain, and find optimal resonance, pitch, and volume for strong and healthy speaking. Our singing voice therapists help professional vocal performers improve vocal range, endurance, and voice quality. This therapy is often an essential part of voice recovery that's not typically available at non-specialist ENT clinics.
Microsurgery
In some cases, surgery may be recommended to remove noncancerous vocal cord nodules, cysts, or polyps. While you are under general anesthesia, tiny surgical instruments are inserted through your mouth into your throat. The surgeon makes a very small incision away from the vibrating edge of your vocal cord, and a tiny flap of tissue is lifted so the growth can be removed. This technique reduces the risk of scarring and offers the best voice outcomes. Voice therapy after microsurgery is essential for optimal recovery.
Vocal Cord Laser Surgery
If your vocal cord lesions are being fed by blood vessels, they might be able to be removed with a laser. This procedure can be done in a doctor’s office while you are awake or in the operating room under general anesthesia. The surgeon inserts a thin scope into your nose and throat and uses laser beams to shrink the lesion. Voice rest and voice therapy are usually necessary after this procedure. Some patients need a second procedure to fully remove the vocal cord lesion.
Medical Management
Your laryngologist may prescribe medications to treat medical problems that may contribute to voice disorders. When needed, your laryngologist will refer you to the appropriate specialist for further treatment of these conditions.
Tests for Vocal Cord Nodules, Cysts, and Polyps
A comprehensive evaluation assesses your voice use patterns -- how much you speak, sing, or use a loud voice, and what your voice sounds like. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illnesses. We will perform a head and neck examination and a visual examination of your voice box. Tests may also be necessary to create an individualized treatment plan.
For singers, a thorough singing voice evaluation assesses your pitch/vocal range, loudness range, vocal stamina, breath support, resonance, and register transitions. Our singing voice specialists will identify any muscle tension that may be contributing to your voice problem and evaluate your vocal technique relative to your singing style. We also identify strategies to optimize your vocal hygiene and vocal pacing. If needed, we will advocate for your vocal health with directors, producers, tour managers, and other artistic personnel. If you are a performer and have an urgent need for a voice evaluation prior to a performance, please call 919-681-4984 to arrange a timely appointment.
Videolaryngostroboscopy
Videolaryngostroboscopy is the gold standard when evaluating the vocal cords and voice box. This detailed visual exam enables your provider to observe how your vocal cords vibrate while you speak or sing and to look for lesions, stiffness, paralysis, irregular movements, throat strain, incomplete closure of the vocal cords, or other physical contributors to your voice problem. It is typically only available at specialized ear, nose, and throat (ENT) centers like Duke.
A tiny camera attached to a small tube called an endoscope is inserted through your nose, allowing your provider to see your vocal cords and larynx (voice box). The camera records while a flashing strobe light simulates slow motion video capture of your vocal cords moving. Compared to a still photo, this video allows your provider to see subtle changes in how your voice box and throat function when you make different sounds. It takes only about a minute, and your nose may be sprayed with topical anesthetic to numb and open the nasal passages to make it more comfortable for you. After the exam, your team will review the recording with you to determine an accurate diagnosis and treatment plan.
