What are vocal cord lesions?
Vocal cord lesions, also known as vocal fold lesions, are benign (noncancerous) growths that include nodules, polyps, and cysts. All can cause hoarseness and may be associated with vocal overuse or vocal cord trauma.
Vocal cord nodule
Vocal cord nodules, sometimes called singer’s nodules or nodes, result from repetitive overuse or misuse of the voice. These callous-like growths develop in the midpoint of the vocal folds. Vocal cord nodules look like calluses under the microscope and are occasionally associated with abnormal blood vessels. Women between the ages of 20 and 50 years old are more prone to vocal cord nodules, but both men and women can be affected.
Vocal cord polyp
Vocal cord polyps are different from nodules because they can occur on either one or both vocal cords. They tend to be more vascularized than nodules, meaning they have more blood vessels and appear reddish in color. These growths can vary in size and shape, but are usually larger than nodules and resemble blisters. Like vocal cord nodules, polyps can be caused by overuse or misuse of the voice, but can also be caused by a single episode of vocal abuse (such as yelling at a sports event). Another type of vocal cord polyp, polypoid corditis (Reinke’s edema), is associated almost exclusively with smoking.
Both vocal cord nodules and polyps can be caused by different forms of trauma, including singing (particularly in professional singers), screaming, cheerleading, and excessive talking (such as that by a teacher, coach, salesperson or radio personality). Other causes include extra muscle tension when speaking, smoking, alcohol use, sinusitis, allergies, and rarely, hypothyroidism.
Vocal cord cyst
Vocal cord cysts are growths that have a sac around a fluid-filled or semisolid center. These are less common than vocal cord nodules and polyps. There are two types of vocal cord cysts, mucus retention cysts and epidermoid (or sebaceous) cysts. Cysts are not typically associated with overuse of the voice or vocal fold trauma.
Vocal cord lesions also can be caused by using the voice while one is sick with an upper respiratory infection or laryngitis.
Symptoms and Causes
What are the symptoms of vocal cord lesions?
Vocal cord lesions can result in hoarseness, breathiness, multiple tones, loss of vocal range, vocal fatigue or loss of voice.
Patients with vocal cord nodules or polyps may describe their voice as harsh, raspy, or scratchy. There may be frequent voice breaks, easy vocal fatigue with use or there may be a decreased range of vocal sounds. Pain is another symptom that is felt as a shooting pain from ear to ear, general neck pain or as a lump in the throat. Patients may also experience frequent coughing, throat clearing, or general fatigue.
Diagnosis and Tests
How are vocal cord lesions diagnosed?
If a patient experiences a hoarse voice, pain or other symptoms for more than two to three weeks, he or she should visit an otolaryngologist (ear, nose, and throat doctor) or see a subspecialized laryngologist who has extra training in caring for the disorders affecting the voice box. The doctor will examine the patient’s head and neck, as well as get a voice use history. The otolaryngologist then has the ability to evaluate the patient’s vocal cords with a special scope, often using a special strobe light to see the vibration of the vocal cords. Additional testing and treatment will be determined based on this initial examination.
Management and Treatment
How are vocal cord lesions treated?
The correct diagnosis of vocal cord lesions is very important because therapy can range from conservative behavioral, medical, and dietary treatments to more invasive treatments like surgery.
Nodules are typically treated conservatively with voice therapy and behavioral modification under the guidance of a speech language pathologist. Surgery is reserved for refractory lesions or in situations where vocal needs are not being met with voice therapy alone. In contrast to nodules, polyps and cysts do not typically respond to voice therapy and are best managed with a surgical approach.
Treatment of underlying medical problems that affect the voice, such as reflux, allergies, and sinusitis, may help lessen the severity or occurrence of vocal lesions and enhance vocal hygiene in general. Behavioral intervention for smoking cessation, stress reduction, and improved vocal awareness may also ease voice problems. Voice therapy typically reinforces these behaviors and provides techniques and strategies to maximize vocal efficiency and function.
How can I prevent a vocal cord lesion?
If you have a vocal cord disorder, you can:
- Stop smoking, and avoid being in smoke-filled rooms.
- If you have hypothyroidism, sinusitis, allergies, or reflux, get treatment.
- Avoid excess use of alcohol and limit caffeine intake.
- Drink plenty of water.
- Get a good night’s sleep.
- Avoid excessive talking or speaking loudly without adequate vocal rest.
- Use a microphone.
- Use a humidifier in your home.
- Warm up your voice before singing or prolonged speaking.
- Rest your voice in anticipation of future speaking obligations.
- Avoid singing or excessive talking if you have an upper respiratory infection.
- Wash your hands often.
- Use stress reduction techniques, cognitive therapy, or yoga to lessen muscle tension.