Vocal Fold Nodules, Polyps & Cysts

Anatomy of the Condition

The vocal folds (or cords) are inside the larynx or voice box. These structures open for breathing. They come together during swallowing. They vibrate as air passes between them during speaking or singing. Fine layers with a soft outer cover make up the vocal folds. A stiffer ligament lies below the thyroarytenoid muscle, connecting deep in the ligament. The thyroarytenoid muscle makes up the bulk of the vocal fold.

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

Vocal fold polyps are generally softer masses. They form more like blisters and can appear on one or both of the vocal folds.

Vocal fold cysts are masses located deep in the surface of the vocal fold. They result from entrapment of some of the lining of the vocal fold under the lining. Plugging of a mucous-secreting gland beneath the vocal fold can also cause cysts.

Causes or Contributing Factors

The most common causes of vocal nodules and vocal fold polyps are voice misuse and abuse. Voice abuse and misuse may also cause vocal fold cysts, or they may arise spontaneously. Poor vocal hygiene often contributes.

Symptoms

Symptoms that may occur with vocal fold, polyps and cysts may include:

  • 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

Our team will discuss your symptoms and medical history. We will perform a thorough head and neck examination. Our evaluation team often involves several members of the Emory Voice Center. We will assess vocal quality, efficiency, and proper speaking technique.

We may complete a laryngeal videostroboscopy. In this minimally invasive procedure, we use an endoscope (a small tube equipped with a fiber optic camera.) A stroboscopic light source lets us check laryngeal function and vibration.

We may recommend microlaryngoscopy. A physician will examine the vocal folds of the larynx with magnification tools. We conduct this procedure under general anesthesia.

Non-Operative Treatments

Voice therapy followed by proper voice use and care can often reduce or eliminate voice problems from voice nodules, polyps, and sometimes 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 Treatments

Vocal nodules, vocal polyps or vocal cysts which do not respond to voice therapy can be removed surgically. In these cases, we use laryngeal microsurgery, which offers effective results.