Vocal Cord Lesions

What are vocal cord lesions (nodules, polyps and cysts)?

Vocal cord lesions, also known as vocal fold lesions, can be benign (noncancerous) or malignant (cancerous) growths that can form on your vocal cords. This article focuses on benign vocal cord lesions.

Your vocal cords are two bands of muscle and vibratory tissue inside your larynx (voice box). They come together and vibrate to produce sound when you speak, sing or use your voice in other ways.

Lesions on your vocal cords can change your voice, making it difficult or even painful to talk or sing.

Types of vocal cord lesions

Benign lesions include vocal cord nodules, polyps and cysts.

Vocal cord nodules

Vocal cord nodules, sometimes called singer’s or screamer’s nodes, can form if you’re repeatedly misusing or overusing your voice. These callus-like growths develop in the midpoint of your vocal cords. This part of the vocal cords gets used most often when you’re using your voice. Often, nodules develop on both vocal cords.

Anyone can get them, but they’re most common in children, heavy voice users such as teachers, trainers and coaches, and professional voice users such as singers and speakers.

Vocal cord polyps

Vocal cord polyps, like nodules, can result from repeatedly overusing or misusing your voice. They can also form after a single episode of vocal abuse (like yelling at a sports event). Polyps can vary in size and shape, but they’re usually larger than nodules. They typically form on one vocal cord, but the friction from a single polyp rubbing against the other vocal cord may cause an additional polyp to form.

A specific type of vocal cord polyp, polypoid corditis (Reinke’s edema), is associated almost exclusively with smoking. If you smoke and become hoarse, you should see a provider to evaluate you for this condition, as well as malignant growths.

Anyone can develop vocal cord polyps, but they’re more common after an episode of voice overuse such as yelling or a sudden loss of voice.

Vocal cord cysts

Vocal cord cysts are growths that have a sac around a fluid-filled or semisolid center. There are two types of vocal cord cysts: mucus retention cysts and epidermoid (sebaceous) cysts. Vocal cord cysts are less common than vocal cord nodules and polyps but can cause many of the same symptoms. They’re not necessarily associated with voice overuse.

What are the symptoms of vocal cord lesions?

The most common symptom of a vocal cord lesion is hoarseness or a raspy voice. Still, symptoms depend on the lesion’s size and how much it interferes with your vocal cords opening, closing and vibrating together.

Symptoms include:

• Hoarseness.
• Breathiness.
• Vocal fatigue.
• Loss of your voice.
• Loss of your vocal range.
• A voice that breaks easily.
• A harsh, raspy or scratchy voice.
• Frequent coughing, throat clearing or general fatigue.
• General neck pain or a shooting pain that travels from ear to ear.

What causes vocal cord lesions?

Nodules and polyps form over long periods of overusing your voice or using your vocal cords incorrectly. Speaking or singing for extended periods, yelling or straining your voice can all cause your vocal cords to become irritated and inflamed, eventually causing lesions. Singing (particularly in professional singers), screaming and frequent talking (for instance, if you’re a teacher, coach or salesperson) can all lead to nodules or polyps.

Other factors can make you susceptible to lesions or worsen them. These include:

• Smoking.
• Sinusitis.
• Allergies.
• Hypothyroidism.
• Chronic acid reflux (GERD).
• Consuming excessive alcohol or caffeine.
• Using your voice when you’re sick with a cold or upper respiratory infection.

Vocal cord cysts can form if a gland in your vocal cord gets blocked or fragments of cell debris get trapped inside vocal cord tissue.

How are vocal cord lesions diagnosed?

A healthcare provider will examine your head and neck and ask how you’ve been using your voice. They may perform tests to examine your vocal cords directly, including:

• Laryngoscopy: Healthcare providers perform this test to examine your voice box. They insert a thin tube through your nose and mouth with special lights and a video camera that allows them to see your voice box.
• Stroboscopy: Healthcare providers perform this test to see how your vocal cords vibrate. They insert a small scope into your nose or throat, above your vocal cords. The scope connects to a special strobe light that flashes when your vocal cords vibrate. This test is the gold standard for evaluating hoarseness. Laryngologists or speech-language pathologists with specialization in voice typically perform and interpret this procedure.

How are vocal cord lesions treated?

Therapy can range from conservative behavioral, medical and dietary treatments to more invasive treatments like surgery.

• Voice therapy: A specialist called a speech-language pathologist might work with you during voice therapy sessions. Voice therapy teaches how to use your vocal cords so they can heal. It can also teach you how to prevent lesions or voice injuries in the future. Nodules are typically treated conservatively with voice therapy under the guidance of a speech therapist.
• Behavioral modifications: Behavioral interventions can help you make lifestyle adjustments to help care for your voice. Quitting smoking, reducing stress and improving your diet can complement voice therapy to ease your symptoms and heal vocal cord lesions.
• Treatments for underlying medical problems: Treatments that address underlying issues that cause vocal cord inflammation, such as reflux, allergies and sinusitis, can help heal lesions and lessen symptoms.
• Surgery: You may need surgery for nodules that don’t improve with more conservative treatments, like voice therapy. You’ll likely need surgery if you have a polyp or cyst. Unlike nodules, polyps and cysts don’t typically improve with voice therapy. Still, you may need voice therapy after surgery to reduce your risk of irritating your vocal cords and developing new lesions.

How can I prevent a vocal cord lesion?

To reduce your risk of developing a vocal cord lesion, you should avoid:

• Singing or talking excessively if you have an upper respiratory infection.
• Talking excessively or speaking loudly without adequately resting your voice.
• Drinking alcohol excessively and consuming too much caffeine (which dry out your vocal cords).
• Smoking or being in smoke-filled rooms.

You can also put healthy habits into place to care for your vocal cords and reduce your risk of getting sick.

• Drink plenty of water.
• Wash your hands often.
• Get a good night’s sleep.
• Use a microphone if you need to project your voice.
• Warm up your voice before singing or prolonged speaking.
• Rest your voice in anticipation of future speaking obligations.
• Use a humidifier in your home to keep your vocal cords hydrated.
• Use stress reduction techniques, cognitive therapy or yoga to lessen muscle tension.

Get treatment for conditions associated with vocal cord lesions, like GERD, sinusitis, allergies and hypothyroidism. See a provider who specializes in voice if you’re concerned you may be developing a voice problem. Early interventions can often prevent invasive treatments such as surgery.

What can I expect if I have vocal cord lesions?

Your outlook depends on your lesion type and how severely it’s impacting your vocal cords. Untreated nodules, polyps and cysts can cause long-term damage to your vocal cords. Untreated cysts may potentially burst, causing complications.

With treatment, your outlook is excellent. Nodules usually improve within two to six months with voice therapy or vocal rest. Surgery to remove polyps or cysts, alongside voice therapy and vocal rest, can help return your voice to normal.

What happens to untreated vocal cord nodules?

Untreated vocal nodules can cause you to further strain your voice and injure your vocal cords. Often, nodules improve with voice therapy and behavior modifications alone. Most people don’t need surgery. Still, you’ll need to learn ways to care for your vocal cords as they heal. Healthcare providers, like speech-language pathologists, can teach you how to use your voice so your nodes shrink or go away.

Are vocal cord nodules serious?

Vocal nodules are benign, which means they won’t cause damage throughout your body like a malignant (cancerous) growth can. Still, they can feel painful and affect your ability to communicate. If vocal health is an important part of your career and well-being (for example, if you’re a singer, salesperson, teacher, etc.), having vocal nodules can feel very serious.

The good news is that most vocal nodules are treatable without surgery. They’re also usually preventable if you’re taking steps to care for your voice.

Do nodules on vocal cords go away?

Most nodules go away once you stop misusing your voice. Getting treated for underlying conditions that may cause vocal cord irritation can help, too. Working with a speech-language pathologist can help you identify what you’re doing that caused vocal nodules and what may be worsening them. Once you’re informed, you’ll know what behavior to change.

When should I seek care?

If you’re hoarse or have other symptoms of a vocal cord lesion for more than two to three weeks, see an otolaryngologist (ear, nose and throat doctor). Or visit a subspecialized laryngologist with extra training in caring for voice disorders.

A note from Cleveland Clinic

Growths on your vocal cords can interfere with how easily and comfortably you communicate with others. The experience may feel especially stressful if your career depends on being able to speak clearly and project your voice. Don’t delay seeking care if you have ongoing symptoms of a nodule, polyp or cyst. Even benign vocal cord lesions can cause you to overcorrect your voice and damage your vocal cords. Often, preserving your vocal cord function is as simple as allowing your vocal cords time to heal and learning how to prevent future injury through voice therapy.