Vocal cord nodules and polyps
Nodules, polyps and cysts on the vocal cords are not treated the same way. Nodules usually go away with voice therapy, while polyps and cysts most often need surgery. Stroboscopy is the examination that tells them apart.
What are vocal cord nodules and polyps?
They are benign (non-cancerous) growths on the vocal cords that change the way the cords vibrate. Nodules are sometimes called "singer's nodes" or calluses on the vocal cords. Polyps and cysts belong to the same group.
The difference is not just theoretical, because it determines the treatment.
Τα Nodules usually appear on both vocal cords, opposite each other, and are the result of long-term strain.
A polyp is usually on one side only and appears after intense vocal effort or bleeding in the vocal cord.
Η cyst sits inside the lining of the vocal cord and does not go away with voice therapy.
How do nodules and polyps develop?
- Long-term vocal strain, meaning many hours of speaking or singing, often over background noise.
- Poor vocal technique, when the voice is produced with too much tension in the throat muscles.
- Sudden vocal injury, such as a loud scream, which can cause bleeding and later a polyp.
- Silent reflux (laryngopharyngeal reflux) and smoking, which keep the lining of the vocal cords irritated.
Γι' αυτό τα οζίδια εμφανίζονται δυσανάλογα συχνά σε επαγγελματίες φωνής, δηλαδή σε εκπαιδευτικούς, τραγουδιστές, ηθοποιούς και ψάλτες.
When should you get it checked?
The main symptom is and hoarseness that won't go away. It often comes with a voice that tires early in the day, loss of the high notes, a feeling of effort to be heard and a constant need to clear your throat.
An examination is needed once hoarseness has lasted longer than 3 weeks. If you rely on your voice for work, there is no waiting period. If your voice suddenly went while you were pushing it, the examination should happen within the next few days, because it may be bleeding in the vocal cord, which, if treated in time, will not turn into a polyp.
What happens at the appointment?
After talking through your history the voice box is examined with a thin, flexible endoscope (laryngoscopy) at the practice, with no preparation needed. The examination takes a few minutes and does not hurt.
Why is stroboscopy needed?
A standard endoscopy shows that there is something on the vocal cord, but not what it is. Stroboscopy shows the vocal cords in slow motion as they vibrate, and this reveals whether the wave of the lining is interrupted, which is what distinguishes a cyst from a nodule or a polyp. Without it, a cyst may be treated for months with voice therapy that will never solve the problem.
Treatment
Non-surgical treatment
For nodules, the first choice is voice therapy with a speech therapist, because it addresses the cause and not just the finding. It is combined with changes to the way you use your voice at work and with treatment of reflux, where present. International guidelines recommend voice therapy as the first-line treatment for these lesions.
Surgery
Surgery is recommended when the lesion does not go away with non-surgical treatment, and from the outset for most cysts and large polyps. It is done by microlaryngoscopy, meaning microsurgery on the voice box through the mouth, under general anesthesia and without any external cut.
There is one principle: the lesion is removed and the vibrating lining of the vocal cord is preserved, because the quality of the voice depends on it. That is why the operation is not judged by how clean the vocal cord looks right afterwards, but by how the voice sounds months later.
After surgery
A period of voice rest follows, set by the surgeon depending on the findings and the extent of the lesion. Voice rest does not mean whispering, it means silence, because forced whispering strains the voice box.
You return to using your voice gradually, with guidance. For people who rely on their voice for work, this is planned around their schedule, so that the return to the stage or the classroom does not fall in the most delicate period. Voice therapy continues afterwards too, because if the cause remains, the lesion can come back.
Frequently asked questions
Yes. Nodules, polyps and cysts are benign lesions, but the diagnosis can only be made after examining the voice box.
No. The aim of the surgery is exactly the opposite, which is why the vibrating lining of the vocal cord is preserved.
Voice rest is set by the surgeon depending on the findings and the lesion, followed by a gradual return with guidance.
They can, if the cause that created them remains. That is why voice therapy continues after surgery too.
No. For nodules the first choice is voice therapy, and surgery is recommended when the lesion does not go away.
In most cases yes, with a gradual return and monitoring of your vocal range.
Book your appointment
Hoarseness that won't go away
Longer than 3 weeks
However much it bothers you, and sooner if you rely on your voice for work.
Sudden loss of voice
Within the next few days
Especially if it happened while you were pushing your voice, without a cold beforehand.
Second opinion before surgery
When surgery has already been recommended to you
With the findings of your examination, we can book an appointment in person or online and discuss whether there are alternatives.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγή: Stachler RJ et al., Clinical Practice Guideline: Hoarseness (Dysphonia) — Update, AAO-HNSF, 2018.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
