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Nodules, Polyps, and Cysts |
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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.
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:
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Vocal fatigue
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Unreliable voice
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Delayed voice initiation
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Low, gravelly voice
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Low pitch
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Voice breaks in first passages of sentences
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Airy or breathy voice
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Inability to sing in high, soft voice
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Increased effort to speak or sing
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Hoarse and rough voice quality
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Frequent throat clearing
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Extra force needed for voice
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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.
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