The vocal cords are situated in the larynx (voice box), and they vibrate together in order to create sound or speech. Lesions that occur on the vocal cord lesions can be either benign or malignant (cancerous). Malignant vocal cord lesions will be discussed separately. The cause of benign vocal cord lesions is thought to be due to voice overuse. This may mean excessive shouting, singing with improper technique, or violently coughing during a prolonged respiratory infection.
The most common benign vocal cord lesions are vocal cord cysts, polyps, nodules, and contact ulcers (see figures below). A vocal cyst is a firm fluid collection that occurs inside the vocal cord. It is usually the response to injury or vocal abuse. After repetitive misuse, fluid within the vocal cord walls itself off and forms a cyst. The size of the cyst will affect the degree of disruption to normal vocal cord vibration and associated hoarseness.
Vocal cord polyps can take on a number of forms. They are usually larger than nodules, and may appear as a swelling or a stalk-like growth. Polyps appear on either one or both of the vocal cords, and they are usually larger than vocal cord nodules. Polyps may also be referred to as polypoid degeneration or Reinke's edema.
Vocal cord nodules typically occur opposite each other on both vocal cords. They can best be understood as calluses on the vocal cords. Similar to calluses on one’s feet that occur from walking barefoot, the vocal cord nodules usually regress when voice overuse is stopped.
A contact ulcer is a unilateral or bilateral erosion of the mucous membrane of the vocal cord at the junction with the vocal process, a portion of the arytenoid cartilage that attaches to the vocal cord. They are also caused by voice abuse, and are common in singers.
A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion. Other symptoms can include: vocal fatigue, voice cutting off during speech, a low, gravelly or husky voice, a weak or breathy voice, inability to sing or project voice as previously, pain with speaking or swallowing, and frequent throat clearing. These symptoms can vary in degree of severity, but vocal cord lesions generally will not go away on their own.
Diagnosis of a vocal cord lesion begins with a complete history and physical examination. Your physician at Suburban Ear, Nose, and Throat will also perform an office-based laryngoscopy by placing a telescope into your throat to visualize the vocal cords. Sometimes a second exam will follow a trial of voice rest to determine if there has been any improvement.
Typically, benign vocal cord lesions are initially managed conservatively with a trial of voice rest, plenty of liquids, and often voice therapy (provided by a speech pathologist). An anti-reflux medicine to cut down on stomach acid may also be used. When conservative management fails, vocal cord surgery may be necessary.
Surgery, commonly referred to as phonomicrosurgery, will be done under general anesthesia. There are no incisions placed on your neck. Your doctor will place a telescope through your mouth and magnify the vocal cords with a microscope. Using various instruments, the benign vocal cord lesion will be carefully removed. It will be sent to pathology for a biopsy. You will be sent home the same day of surgery, often with a prescribed course of strict voice rest for up to a week.