| Anatomy of the Condition | Causes or Contributing Factors | Symptoms | Diagnosis | Treatments |

Anatomy of the Condition:

The vocal folds are located within the larynx or voice box.  They are structures which open for breathing, and come together during swallowing, and vibrate as air passes between them during speaking or singing.  They are made up of fine layers, with a soft outer cover, a stiffer ligament below this, and a muscle called the thyroarytenoid muscle located deep to the ligament.  The thyroarytenoid muscle makes up the bulk of the vocal fold.

Vocal nodules are benign masses or lumps which form on both vocal folds, impair vocal fold vibration, and cause vocal difficulties.  If untreated, the masses can harden into callus-like growths. 

Vocal polyps are masses which are generally softer, are formed more like blisters and can appear on one or both of the vocal folds.

Vocal fold cysts are masses which are located deep to the surface of the vocal fold.  They result from entrapment of some of the lining of the vocal fold under the lining or from plugging of a mucous secreting gland just beneath the vocal fold.

Causes or Contributing Factors:

The most common causes of vocal fold nodules and polyps are voice misuse and abuse. Vocal fold cysts may also be caused by voice abuse and misuse or they may arise spontaneously.  Poor vocal hygiene, (see healthy voice tips), is often a contributing factor.

Symptoms:

• Hoarseness
• Rough or scratchy voice
• Vocal fatigue and strain
• Increased vocal effort
• Vocal onset delays
• Day to day variability in the voice
• Loss of upper range in singing
• Difficulties with vocal register changes in singing
• Airy quality to the voice

Diagnosis:

The voice team will ask the patient about symptoms and their medical history, followed by a thorough head and neck examination. The examination likely will involve several members of the voice team to assess vocal quality, efficiency, and proper speaking technique.

Laryngeal videostroboscopy may be required.  This is a procedure using a flexible and/or rigid endoscope coupled to a video monitor and a stroboscopic light source to allow for detailed visual evaluation of laryngeal function and vibration.

Microlaryngoscopy may be required.  It is a procedure conducted under general anesthesia which allows the physician to examine the vocal folds of the larynx with magnification tools. 

Treatments:

Non-Operative
Voice therapy followed by proper voice use and care is often effective at reducing or eliminating voice problems from voice nodules, polyps, and occasionally cysts.  A speech pathologist and singing specialist can work with the patient to change behaviors and voice patterns that may be exacerbating the condition.  Medications are often used to treat associated problems.

Operative
Vocal fold nodules, polyps, or cysts which do not respond adequately to voice therapy can be removed surgically with laryngeal microsurgery with highly effective results.