Larynx is like a wind instrument. Voice is produced when air passes through the larynx vibrating the vocal cords, which are two folds present in the larynx. The benign lesions of the vocal cords are classified as neoplastic and non neoplastic lesions. Non neoplastic lesions comprise vocal nodules, vocal polyps, and cysts. Most lesions form due to various types of vocal cord lesions.
This blog is focused on benign vocal cord lesions. Vocal cords are two bands of muscles that are responsible for production of sound as air passes through them. The air causes the vocal cords to vibrate, and the vibrations are then amplified by various structures like the mouth, pharynx, etc.
These lesions often make it difficult and painful to talk or sing.
Vocal nodules
These are symmetrical lesions, that is, they occur in the same location on both vocal cords. Mostly commonly they occur at the junction of anterior 1/3rd and posterior 2/3rd. As it is the point of maximum vibration, it is often subjected to maximum trauma.
The lesions are often the size of a pea or a pinhead. It occurs most commonly in teachers, singers, vendors, actors, etc. Therefore, it is also known as the screamer module.
Sometimes, the lesions can also be seen in school going children who are very talkative.
Vocal polyp
These lesions are unilateral. The location is similar to vocal nodules, that is, the point of maximum vibration. Vocal polyps are soft, smooth, and pedunculated growth. They can vary in shape and size. Polyps are often larger than nodules. The polyps flop up and down with respiration.
It is caused by sudden shouting or an episode of voice abuse in an unprepared larynx (screaming at a sports event). Due to this there occurs submucosal hemorrhage, followed by edema.
Reinke's edema
It is a specialized form of polyp. It is also known as bilateral diffuse polyposis. The name Reinke's edema is because there is edema in Reinke's space, it is a space between the mucosa layer covering the vocal cord and the ligament forming the vocal cord.
It usually occurs in smokers and following an episode of voice abuse.
Both the vocal cords show diffuse symmetrical swelling.
Vocal cord cysts
These are another form of vocal cord lesions that are relatively less common. A cyst is a fluid filled sac or a sac with a semisolid center. There are two types of cysts: mucous retention cysts and epidermoid cysts (sebaceous).
They aren't always associated with voice abuse.
Symptoms
Most common symptoms associated with vocal cord lesions are hoarseness of voice and raspy voice. The type and severity of symptoms depends on the size and site of the lesion.
Few of the common symptoms observed in vocal cord lesions are-
Hoarseness of voice.
Raspy, scratchy, or harsh voice.
Breathy voice.
Vocal fatigue.
Loss of voice.
Voice that breaks off easily.
Frequently hawking, or throat clearing due to a sensation of discomfort.
Pain in the throat that increases on speaking.
Generalized neck pain or pain radiating to the ear.
Cause of vocal cord lesions
These lesions are most commonly observed in individuals who have to overuse their voice or sometimes following voice abuse.
Speaking, singing, screaming, or straining the vocal cords cause them to become irritated and inflamed eventually resulting in afro mentioned lesions.
The individuals most susceptible are teachers, singers, sports coaches, those involved in some riots, or anyone who speaks in unnatural low tones for long periods or at high intensities.
Few other factors than increase the susceptibility to the lesions are-
Smoking
Allergies
Sinusitis
Gastro-esophageal acid reflux
Alcohol consumption
Excessive use of voice when you have throat infection
Vocal cord cysts often form when a gland in the vocal cord gets blocked and there is collection of debris and secretions of the gland.
Diagnosis of vocal cord lesions
Your healthcare provider will perform a complete head and neck examination, followed by complete history taking regarding any episode of recent voice abuse, your occupational history and much more. Apart from this they can also visualize your vocal cords by,
Laryngoscopy-
The doctor visualizes your vocal cords by passing a laryngoscope. It is a thin tube that has a camera at the end.
Stroboscopy-
The healthcare provider will pass a scope through your nose or throat till just above the vocal cords. This is a special instrument that helps in visualizing the movements of vocal cords. It flashes light on the movement of vocal cords. The procedure is often performed by ENT surgeons or speech language pathologists who specialize in voice.
Treatment of vocal cord lesions
Based on severity of the condition the treatment can either be conservative, voice therapy, medical treatment or behavioral modification, or it can be surgical.
Speech therapy
It is performed by speech language pathologist/ speech therapist. Speech therapy aims to assist you in learning how to use your voice properly so that the vocal cords can heal. It also helps in preventing further occurrence of the lesions as the chances of reoccurrence are quite common.
Behavioral modification
Lifestyle changes like quitting smoking, reducing stress, improving diet, etc. can complement the speech therapy in your recovery. It also reduces the chances of reoccurrence.
Medical management
Treatment of underlying conditions that cause inflammation of the vocal cords like reflux, Allergies, Sinusitis, can help in healing the lesions and reducing the symptoms.
If there is extensive involvement then surgery is the mainstay followed by speech therapy. Large nodules and polyps are excised with precision under microscope with laser or instruments avoiding any trauma to vocal ligaments.
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Reference-
Diseases of EAR, NOSE & THROAT Book by P. L. Dhingra and Shruti Dhingra