Overview
Our voice is amazing and helps us talk, share feelings, and connect with people. But, like any instrument, our vocal cords can have problems. One common issue is vocal cord lesions. This guide will explain what causes them, what they feel like, how doctors find them, and ways to treat them. Whether you sing for a living, talk a lot as a teacher, or just have voice problems, this article will help you learn about and deal with vocal cord lesions.
The vocal cords are two folds in the middle of the voice box (larynx), where air enters the windpipe. Muscles on the edges of the vocal cords make them come closer when you talk or sing. As the air goes through them, they vibrate and create sounds. Using your voice too much can make them swell and cause nodules to form.1
Vocal cord lesions are abnormal growths or changes in the vocal cords. The quality and tone of the voice can be impacted by these lesions, which can interfere with the vocal cords' regular operation. Vocal cord lesions come in various forms, such as nodules, polyps, and cysts. Each type has distinct characteristics and may require different approaches to diagnosis and treatment.
Types of vocal cord lesions
Nodules
Vocal cord nodules, often known as singer's or screamer's nodes, can develop if your voice is misused or overused regularly. Your vocal cords' midpoint experiences the development of these callus-like growths. When you speak, this portion of the vocal cord is most frequently employed. Nodules frequently form on both vocal cords. Sometimes, there are other things on the vocal cords that can also make the voice hoarse, like vocal exhaustion, voice breakdowns, and a narrower range of voice.
Polyps
Vocal fold polyps are common non-cancerous growths on the vocal cords,2 often causing hoarseness and discomfort, making it hard to communicate. They can happen from infections, acid reflux, and too much speaking. Polyps come with issues like swelling, bleeding, and inflammation. Vocal fold polyps might be related to certain cells in the vocal cord tissue.3 Vocal fold polyps can happen because of smoking and stomach acid coming up, like in a condition called Reinke's edema.2
Cysts
Vocal cord cysts are like little bags filled with liquid or mucus that can form on or inside the vocal cords. They might be near the surface or deeper inside. These cysts usually happen when something blocks a tiny gland's path in the vocal cord, causing fluid or mucus to build up. They can mess up how the vocal cords move and make your voice sound different, making it harder to talk or sound hoarse.
They make up about 6% to 13% of non-cancerous throat growths and are more common in women. There are two main types: mucous retention and epidermoid cysts. Mucous retention cysts are clear and contain jelly-like stuff, usually found on the inner part of the vocal cord. Epidermoid cysts are solid and have a cheese-like substance inside, often found on the top part of the vocal cord. Both types cause voice problems because they change how the vocal cords work. Usually, surgery is needed to treat these cysts.4
Causes and symptoms of vocal cord lesions
Nodules and polyps develop from long-term voice overuse or incorrect vocal cord use. Speaking, singing, yelling, and straining your voice for extended periods can lead to irritation and inflammation, causing these lesions. Certain jobs like teaching, coaching, or sales, as well as singing professionally or screaming, can increase the risk of nodules or polyps.
Other factors that can make you more prone to these issues or worsen them include:
- Smoking
- Sinus problems (sinusitis)
- Allergies
- Hypothyroidism
- Gastroesophageal Reflux Disease (GERD) can result in the regurgitation of stomach acid into the throat, causing irritation and inflammation of the vocal cords
- Excessive alcohol or caffeine consumption
- Certain viral infections, such as human papillomavirus (HPV), can lead to the formation of vocal cord papillomas, which are benign growths on the vocal cords
The symptoms of vocal cord lesions can vary depending on the type, size, and location of the lesion. Common symptoms include:
- Hoarseness or voice changes
- Vocal fatigue
- Voice breaks or cracks
- Rough, raspy, or breathy voice
- Trouble projecting the voice
- Limited vocal range
- Throat or neck discomfort
- Extra effort to make sounds
- Frequent throat clearing or coughing
It is important to seek medical evaluation if you experience persistent or worsening symptoms, as early detection and treatment can lead to better outcomes.
Diagnosis of vocal cord lesions
If you have symptoms of vocal cord issues, a healthcare specialist like an ear, nose, and throat doctor or a speech therapist will check you. They will:
- Medical History and Symptoms Assessment: Ask about your medical history, symptoms, and habits related to your voice
- Physical Examination: Examine your throat and neck, often using a tool called a laryngoscope to look closely at your vocal cords
- Voice Assessment: Test your voice by having you make different sounds and notes to see how it works
- Instrumental Evaluation: Sometimes, they might use special tools like stroboscopy, electroglottography (EGG), acoustic analysis, or imaging scans to get more detailed information about your vocal cord problems1
With all this information, they will determine what's wrong with your voice and create a plan to treat it.
Management and treatment
Treatment options for vocal cord problems depend on factors like the type, size, location, and how much they affect your voice. The main goals are to improve your voice, reduce symptoms, and fix how your vocal cords work. There are two types of treatments: non-surgery and surgery.
Non-Surgery options
- Rest your voice and avoid things that strain your vocal cords, like talking too much or singing
- Work with a speech therapist who specializes in voice problems to learn better voice techniques and habits
- Sometimes, medication can help if things like acid reflux or allergies are making the vocal cord problem worse
Surgery options
If Non-surgery treatments don't work well or if the vocal cord problem is severe, surgery might be needed.2
- Microsurgery, like using a tiny camera and special tools, can remove or shrink the vocal cord problem
- In some cases, they may inject special material into the vocal cord to make it work better
- If the vocal cord is very weak, they might reposition it to improve voice quality
- Your healthcare provider will help you decide on the best treatment based on your situation
After treatment
- After surgery, you'll need some rest and voice therapy to get better
- You'll have follow-up appointments to check your progress
- To keep your voice healthy, it's important to drink enough water, avoid coughing or clearing your throat too much, stay away from things that irritate your throat, and use good voice techniques when speaking or singing
FAQ’s
When should I seek the attention of a doctor for vocal cord lesions?
If Hoarseness or voice changes last longer than usual without improvement, consult your doctor. For difficulty swallowing or breathing, seek immediate medical attention.
How can vocal cord lesions affect me?
Your outlook depends on the type and severity of your vocal cord lesion. Untreated nodules, polyps, and cysts can cause lasting damage. However, with treatment, your outlook is positive. Nodules often improve in two to six months with voice therapy or rest, while surgery, along with therapy and rest, can restore your voice after removing polyps or cysts.
Who is at risk of vocal cord lesions?
People who use their voices frequently or work in noisy settings are more likely to develop voice issues. Occupations with a higher risk of voice disorders include singers, actors, teachers, attorneys, sales representatives, receptionists, and phone support staff.
How can I prevent vocal cord lesions?
Maintaining a healthy voice and lowering the risk of vocal cord issues involves staying hydrated, avoiding smoking and second-hand smoke, warming up and cooling down your voice, using proper vocal techniques to prevent strain, not shouting or speaking loudly or excessively (using a microphone when necessary), managing allergies and acid reflux with your doctor's guidance, and taking breaks during extended periods of speaking to prevent vocal cord strain.1
What are the risk factors for vocal problems?
Overusing your voice, talking loudly, and using excessive force can lead to vocal cord swelling and hoarseness. Poor posture, frequent vocal use in jobs like teaching or singing, and incorrect singing techniques can also raise the risk. Smoking, vocal cord abuse, and hormonal imbalances, especially during puberty, can contribute to the development of vocal cord lesions.1,2
Voice problems can also be caused by various factors that include laryngitis, smoking, and vocal cord paralysis. In rare cases, they may be due to cancer or psychological issues.1
Summary
Vocal cord lesions can significantly impact your voice and overall quality of life, but with proper understanding, diagnosis, and treatment, most vocal cord lesions can be effectively managed. If you are experiencing voice-related difficulties or persistent hoarseness, it is important to seek evaluation and guidance from a qualified healthcare provider. By adopting healthy vocal habits, practicing good vocal hygiene, and seeking appropriate treatment when needed, you can protect and preserve your vocal health for years to come. Remember, your voice is unique and deserves the care it needs to continue serving as a powerful tool for communication and self-expression. These growths or abnormalities on the vocal cords can be benign or non-cancerous and are often caused by factors like voice overuse, incorrect vocal techniques, smoking, or hormonal imbalances. Common symptoms include hoarseness, vocal fatigue, and difficulty producing sound. Treatment options range from non-surgical approaches like voice therapy to surgical interventions, depending on the severity and type of the lesion.
References
- Vocal nodules: Overview. In: InformedHealth.org [Internet] [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG); 2018 [cited 2023 Oct 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534635/
- Vasconcelos D de, Gomes A de OC, Araújo CMT de. Vocal Fold Polyps: Literature Review. Int Arch Otorhinolaryngol. 2019 Jan;23(1):116–24.
- Tateda Y, Ikeda R, Kakuta R, Izuhara K, Ogawa T, Ise K, et al. Immunohistochemical Localization of D-β-Aspartic Acid and Periostin in Vocal Fold Polyps. Tohoku J Exp Med. 2023;260(3):223–30.
- Kirke DN, Sulica L. The Natural History of Vocal Fold Cysts. The Laryngoscope. 2020;130(9):2202–7.
