Vocal Cord Nodules and Polyps
Teachers, singers, sports fans, and energetic children who continuously shout while playing are prone to vocal cord nodules and polyps. Vocal cord nodules, resulting from hypertrophy of fibrous tissue, form at the point where the cords come together forcibly.
Nodules tend to be benign growths that resemble calluses on the vocal cords. Vocal cord polyps are chronic, subepithelial, edematous masses that also are common in adults who smoke, live in dry climates, or have allergies. Both nodules and polyps have good prognoses unless continued voice abuse causes recurrence with subsequent scarring and permanent hoarseness.
Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by prolonged vocal abuse, but may also occur after a single, traumatic event to the vocal folds, such as yelling at a concert. Long-term cigarette smoking, hypothyroidism, and gastroesophageal reflux may also cause polyp formation.
Signs and SymptomsThe patient may report painless hoarseness and may display a breathy or husky voice. Assess for factors that might have contributed to dysphonia.
Diagnostic testsIndirect (mirror) or direct laryngoscopy enables visualization of nodules and shows small, red nodes that eventually become white, solid nodes on one or both cords. In the patient with polyps, laryngoscopy reveals unilateral or, occasionally, bilateral sessile or pedunculated polyps of varying sizes anywhere on the vocal cords.
Conservative management of small vocal cord nodules and polyps includes humidification, speech therapy (voice rest and training to reduce the intensity and duration of voice production), and treatment of any underlying allergies. Histamine2 inhibitors may be used to treat gastroesophageal reflux, antibiotics for infection, steroids to reduce swelling, and botulism injection to paralyze spastic movement.
When conservative treatment fails to relieve hoarseness, nodules or polyps require removal under direct laryngoscopy. Microlaryngoscopy may be performed for small lesions to avoid injuring the vocal cord surface. For bilateral nodules or polyps, excision may be performed in two stages to allow one cord to heal before surgery on the other cord. Two-stage excision prevents laryngeal web, which occurs when epithelial tissue is removed from adjacent cord surfaces and these surfaces grow together.
For children, treatment consists of speech therapy. If possible, surgery should be delayed until the child is old enough to benefit from voice training or until the child can understand the need to abstain from voice abuse.
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