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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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