Our voices are a part of us. We rely on our vocal cords every day. Our ability to communicate affects not only our ability to perform everyday tasks, but it is also how other people judge us. Having a lesion or polyp on your vocal cords will affect your voice.
The vocal cords are finely tuned instruments. Nerves and muscles control them, and they have a membranous covering. It is not just the lining of the vocal cords becoming red or swollen, as your vocal cords produce mucosal waves that create subtleties of sound and resonance that make your voice your own.
A disturbance of the mucosal wave or the mobility of the vocal cord can have dramatic effects on the quality of our voices, our ability to project sounds, and our intonation.
When a patient with change in voice (dysphonia) is seen by a healthcare professional, and there are no other potential causes, it is a clinician’s task to determine an accurate diagnosis and timely and appropriate treatment, or in some cases, voice therapy.
Yes, that is right. Even in cases where there is a lesion, something that should not be there, on the vocal cords themselves, often speech therapy alone may be effective.
This concept may be contrary to standard thinking, and as such, surgery to remove the lesion may not always be necessary. In fact, removing the vocal cord lesion, in some cases, may cause more harm than good. The reasons why will be explained in more detail.
The difference between a nodule and a polyp
The longer the voice abuse or misuse goes on, vocal cord nodules can become larger and stiffer. Vocal cord nodules are not cancerous. They can occur on both sides and result in soft, swollen areas on each vocal cord.
Vocal cord polyps are more variable. They can occur on both sides. They look more like a bump or swelling. They can even have a stalk or appear like a blister.
Vocal cord polyps are larger than vocal cord nodules. Often vocal cord polyps are a result of smoking. They can be associated with swelling and fluid that gets trapped between the vocal cord mucosa or lining and the vocal cord muscle (vocalis).
This is called Reinke’s edema, which can also occur in other processes such as inflammation or infection.
Anatomy of the true vocal cord
It is important to understand some of the anatomy of the vocal cords in order to understand how lesions such as vocal cord polyps or nodules can be treated. There are two sets of vocal cords, the true and false.
For the purposes of this discussion, we will home in on the true vocal cords since they are responsible for most of the production of sound, particularly our voice. The false vocal cords are above the true vocal cords and help with sound resonance.
The true vocal cord is composed of five individually identifiable layers. The deepest layer consists of the primary muscle that aids in voluntarily stiffening and thickening the vibratory margin of the cord. Overlying the muscle are a series of layers composed of collagen and elastin to give the vocal cord elasticity and firmness.
The deep and middle layers blend together. This structure is also known as the vocal ligament. It is the transition zone between the muscle and the outer thin layer.
The outer thin layer doesn’t have a clearly defined shape. It takes on its own character and personality in every person. It moves in waves like the surface of water to form its own finely tuned sounds. As you might imagine, these waves can easily be disturbed by swelling, inflammation, infection, lesions like polyps or nodules, and other things.
What causes vocal cord polyps or nodules?
Benign lesions of the vocal cords are presumed to be a result of vocal cord trauma, specifically known as phonotrauma.
Phonotrauma indicates that there is some type of disturbance or disruption of the layers of the vocal cords. Typically, this means you have misused your voice. It is aptly called voice abuse.
Excessive talking, prolonged and excessive loudness, use of the wrong pitch, persistent cough, and throat clearing are all examples of voice abuse. These abnormal behaviors cause stress or trauma to the voicebox.
It is believed that distinct types of voice abuse can contribute to several types of vocal cord lesions. External irritation of the vocal cords by noxious chemicals or smoking can cause characteristic changes in the vocal cord lining. Many of these changes can overlap with the benign lesions and become malignant.
Many doctors believe that smoking is the primary factor for the development of vocal cord polyps, mainly associated with vocal abuse. Tobacco use compromises the vocal cord lining, disrupts the vocal cord mucosal wave, and increases the deterioration of the vocal cord causing the development of vocal cord polyps.
Lastly, weakness or paresis of the vocal cords can lead to vocal cord polyps as well. The weakness or paralysis of the vocal cord can generate excessive forces in the unaffected areas of the voicebox and cause mechanical trauma.
Best way to diagnose vocal cord polyps or nodules
The initial diagnosis is made by indirect laryngoscopy, done by using an old-fashioned dental mirror and a bright light.
With the advent of better technology, most doctors prefer to use flexible fiberoptic nasopharyngoscopy. A bright light source is combined with a thin flexible tube that is passed down into the patient’s nose after topical anesthesia is used.
Most people tolerate the procedure well. This procedure identifies the vocal cord lesion, but today, there is an even better method.
By far, the most sensitive procedure is called videostroboscopy. This is done with a rigid endoscope and a powerful light source through the patient’s mouth.
The images can be placed on a video monitor. The doctor will be able to discern subtle differences in the appearance, pliability, and characteristics of the mucosal wave of the vocal cord.
This means the vocal cord mucosal wave can be analyzed for symmetry, periodicity, amplitude, and vertical phase difference. Suspicious lesions can be carefully evaluated and often it is possible to differentiate between ones that are benign and malignant.
How are vocal cord polyps or nodules treated?
Treatment is either invasive or noninvasive. Removal of the lesions must be done with the utmost care because of the danger of disruption of the normal mucosal wave of the vocal cords.
On the other hand, careful removal of the polyp or nodule can completely solve the problem. The procedure to do this usually is done under general anesthesia in an operating room setting.
The primary goal of treatment is to correct the underlying causative factors, largely through proper use of the voice through voice therapy and education. Of course, eliminating any external factors, particularly getting the person to stop smoking or stop abusing their voice plays an integral part of any plan of action when treating vocal cord polyps or nodules.
Having a lesion, nodule or polyp on your vocal cords will change the quality of your voice.
An ear nose and throat doctor will make the diagnosis, often with a bright light and a mirror.
Video cameras can be used for a more detailed look into your throat.
Voice therapy is one method of treatment, along with surgery.
Eliminate causes which damage your vocal cords, including smoking, talking excessively and too loudly and by treating a persistent cough.
Cleveland Clinic. Vocal Cord Lesions (Nodules, Polyps and Cysts).
Duke Health. Vocal Cord Nodules, Cysts, and Polyps.
University of Michigan. Vocal Fold Lesions, Nodules, Cysts and Polyps.