Vocal Cord Nodules and Polyps
The vocal cords, located in the voice box in the middle of the neck, are two tough, fibrous bands that vibrate to produce sound. They are covered with a layer of tissue that is similar to skin. With use, this layer thickens. With heavy use, the thickening may localize, producing a nodule. Unlike skin, heavy usage over a short time may also produce polyps. A polyp is a soft, smooth lump containing mostly blood and blood vessels. A nodule is similar to a polyp, but tends to be firmer.
Causes and symptoms
Chronic infections caused by allergies and inhalation of irritants, such as cigarette smoke, may produce these lesions, but extensive use of the voice is the most common cause of vocal nodules and polyps. Nodules and polyps are more common in male children, female adolescents, and female adults. This may be due in part to the faster speed at which the cords vibrate to produce higher-pitched voices.
Voice alterations are most apparent in singers, who may notice the higher registers are the first to change. Hoarseness causes others to seek medical attention.
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.
Voice rest is the first choice treatment for polyps. Polyps that appeared suddenly will resolve with a few days of complete silence. Nodules do not disappear with rest. Lesions that have been there longer may be slower to disappear and require voice training by a speech therapist.
Nodules and polyps may be surgically removed, using either conventional techniques or lasers.
Continued overuse of the voice will cause these lesions to regrow.
Careful use of the voice will prevent most vocal cord nodules and polyps. Avoiding inhaled irritants, may also prevent nodules and polyps from forming.
Ballenger, John Jacob. Disorders of the Nose, Throat, Ear, Head, and Neck. Philadelphia: Lea & Febiger, 1991.
J. Ricker Polsdorfer, MD
Laryngitis—Inflammation of the larynx (voice box).
Lesion—A wound or injury.
Otorhinolaryngologist—A physician specializing in ear, nose, and throat diseases. Also known as otolaryngologist.