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Hoarse voice or hoarseness

Hoarseness - what do vocal cord lesions (nodules, polyps and cysts) mean?

Vocal cord lesions also known as vocal fold lesions can be benign or malignant growths that can form on vocal cords.

The vocal cords are two bands of muscle and vibratory tissue inside the larynx that are driven by the muscles of the larynx. They vibrate to produce sound when we speak or sing. Lesions on the vocal cords can change the pitch of the voice, making it difficult and 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 nodes, can occur as a result of overstretching the vocal cords. The callus-like growths develop in the middle part of the vocal cords. This part of the vocal cords gets used most often when you’re using your voice.

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 overuse or misuse of the voice. Polyps can vary in size and shape, but are usually larger than nodules. 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 special type of vocal cord polyps, polypoid chorditis (Reinke’s oedema), is associated with smoking.

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 cysts. Vocal cord cysts are less common than vocal cord nodules and polyps, but can cause the same symptoms. They’re not necessarily associated with voice overuse.

What are the symptoms of vocal cord lesions?

The most common symptom of vocal cord lesion is hoarseness, but symptoms depend on the lesion’s size and how much it interferes with the opening, closing and vibration of the vocal cords together.

Symptoms include:

  • Breathiness;
  • Vocal fatigue;
  • Loss of voice;
  • Loss of voice range;
  • A voice that breaks easily;
  • A harsh, raspy or scratchy voice;
  • Frequent coughing;
  • General neck pain.

What causes vocal cord lesions?

Nodules and polyps form when the vocal cords are overused or misused. Speaking, yelling, singing or prolonged straining of the voice can cause irritation and inflammation of the vocal cords, eventually causing vocal cord lesions. Singing (especially in professional singers), screaming and frequent talking (for example, if you are a teacher, coach or salesperson) can lead to the formation of nodules or polyps.

Factors that can worsen the condition are:

  • Smoking;
  • Sinusitis;
  • Allergies;
  • Hypothyroidism;
  • Chronic acid reflux (GERD);
  • Consuming excessive alcohol or caffeine;

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?

The following examinations  are performed to check the condition of the vocal cords:

  • Laryngoscopy: the study is performed to examine the voice box. A thin tube with special lights and a video camera is inserted through the nose and mouth, which allows the doctor to see the work of the voice box.
  • Stroboscopy: Examination of vocal cord vibration. A small scope is inserted into the nose or throat, above the vocal cords. TheHow are vocal cord lesions treated? scope connects to a special strobe light that flashes when vocal cords vibrate.

Treatment is done both conservatively and surgically.

  • Voice  therapy: Voice therapy teaches how to use the vocal cords to help them heal in time. Through voice therapy, you will learn how to prevent vocal cord lesions. Vocal cord nodules are usually 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: Treating underlying problems that cause vocal cord inflammation, such as reflux, allergies, and sinusitis, can help heal lesions and lessen symptoms.
  • Surgery: Sometimes surgery may be necessary if the condition does not improve with conservative treatment. Surgery is necessary if you have a polyp or cyst because, unlike nodules, polyps and cysts usually do not improve with voice therapy. Voice therapy may be needed after surgery to reduce the risk of vocal cord irritation and the development of new lesions.