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Nodules, Polyps, and
Cysts
The term vocal cord lesion (physicians
call them vocal “fold” lesions) refers to a group of noncancerous
(benign), abnormal growths (lesions) within or along the covering of
the vocal cord. Vocal cord lesions are one of the most common causes
of voice problems and are generally seen in three forms; nodules,
polyps, and cysts.
Vocal Cord
Nodules (also called Singer's Nodes, Screamer's Nodes)
Vocal cord nodules are also known as “calluses of the vocal fold.”
They appear on both sides of the vocal cords, typically at the
midpoint, and directly face each other. Like other calluses, these
lesions often diminish or disappear when overuse of the area is
stopped.
Vocal Cord
Polyp
A vocal cord polyp typically occurs only on one side of the vocal cord
and can occur in a variety of shapes and sizes. Depending upon the
nature of the polyp, it can cause a wide range of voice disturbances.
Vocal Cord
Cyst
A vocal cord cyst is a firm mass of tissue contained within a membrane
(sac). The cyst can be located near the surface of the vocal cord or
deeper, near the ligament of the vocal cord. As with vocal cord
polyps and nodules, the size and location of vocal cord cysts affect
the degree of disruption of vocal cord vibration and subsequently the
severity of hoarseness or other voice problem. Surgery followed by
voice therapy is the most commonly recommended treatment for vocal
cord cysts that significantly alter and/or limit voice.
Reactive Vocal
Cord Lesion
A reactive vocal cord lesion is a mass located opposite an existing
vocal cord lesion, such as a vocal cord cyst or polyp. This type of
lesion is thought to develop from trauma or repeated injury caused by
the lesion on the opposite vocal cord. A reactive vocal cord lesion
will usually decrease or disappear with voice rest and therapy.
Vocal Cord
Nodules (also called Singer's Nodes, Screamer's Nodes)
Vocal cord nodules are also known as “calluses of the vocal fold.”
They appear on both sides of the vocal cords, typically at the
midpoint, and directly face each other. Like other calluses, these
lesions often diminish or disappear when overuse of the area is
stopped.
Vocal Cord
Polyp
A vocal cord polyp typically occurs only on one side of the vocal cord
and can occur in a variety of shapes and sizes. Depending upon the
nature of the polyp, it can cause a wide range of voice disturbances.
Vocal Cord
Cyst
A vocal cord cyst is a firm mass of tissue contained within a membrane
(sac). The cyst can be located near the surface of the vocal cord or
deeper, near the ligament of the vocal cord. As with vocal cord
polyps and nodules, the size and location of vocal cord cysts affect
the degree of disruption of vocal cord vibration and subsequently the
severity of hoarseness or other voice problem. Surgery followed by
voice therapy is the most commonly recommended treatment for vocal
cord cysts that significantly alter and/or limit voice.
Reactive Vocal
Cord Lesion
A reactive vocal cord lesion is a mass located opposite an existing
vocal cord lesion, such as a vocal cord cyst or polyp. This type of
lesion is thought to develop from trauma or repeated injury caused by
the lesion on the opposite vocal cord. A reactive vocal cord lesion
will usually decrease or disappear with voice rest and therapy.
What Are The Causes Of Benign Vocal Cord
Lesions ?
The exact cause or causes of benign vocal cord lesions is not
known. Lesions are thought to arise following "heavy" or traumatic use
of the voice, including voice misuse such as speaking in an improper
pitch, speaking excessively, screaming or yelling, or using the voice
excessively while sick.
What Are
The Symptoms Of Benign Vocal Cord Lesions?
A change in voice quality and
persistent hoarseness are often the first warning signs of a vocal
cord lesion. Other symptoms can include:
● Vocal fatigue
● Unreliable voice
● Delayed voice initiation
● Low, gravelly voice
● Low pitch
● Voice breaks in first passages of sentences
● Airy or breathy voice
● Inability to sing in high, soft voice
● Increased effort to speak or sing
● Hoarse and rough voice quality
● Frequent throat clearing
● Extra force needed for voice
● Voice "hard to find"
When a vocal cord lesion is present, symptoms may increase or decrease
in degree, but will persist and do not go away on their own.
How Is The Diagnosis
Of A Benign Vocal Cord Lesion Made?
Diagnosis begins with a complete history of the voice problem and an
evaluation of speaking method. The otolaryngologist will perform a
careful examination of the vocal cords, typically using rigid
laryngoscopy with a stroboscopic light source. In this procedure, a
telescope-tube is passed through the patient's mouth that allows the
examiner to view the voice box (images are often recorded on video).
The stroboscopic light source allows the examiner to assess vocal fold
vibration. Sometimes a second exam will follow a trial of voice rest
to allow the otolaryngologist an opportunity to assess changes in the
vocal cord lesion.
Other associated
medical problems can contribute to voice problems, such as: reflux,
allergies, medication’s side effects, and hormonal imbalances. An
evaluation of these conditions is an important diagnostic factor.
How Are Benign Vocal Cord Lesions Treated?
The most common treatment options for benign vocal cord lesions
include: voice rest, voice therapy, singing voice therapy, and
phonomicrosurgery, a type of surgery involving the use of
microsurgical techniques and instruments to treat abnormalities on the
vocal cord.
Treatment options can
vary according to the degree of voice limitation and the exact voice
demands of the patient. For example, if a professional singer develops
benign vocal cord lesions and undergoes voice therapy, which improves
speaking but not singing voice, then surgery might be considered to
restore singing voice. Successful and appropriate treatment is highly
individual and includes consideration of the patient’s vocal needs and
the clinical judgment of the otolaryngologist.
Material provided courtesy of the
American Academy of Otolaryngology — Head and Neck Surgery
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