Vocal cord polyps, cysts, and nodules present as lesions on the vocal cord. They are noncancerous growths of varying size and structure. Their major symptom is vocal hoarseness, typically caused by vocal trauma or overuse.
Nodules
Nodules are common vocal cord lesions that typically result from vocal overuse or misuse. By definition they are bilateral, meaning they occur on both vocal cords directly opposite each other. Therefore, nodules are always plural. Nodules are like “calluses” that result from chronic abnormal friction between the cords. Over time these raised “bumps” on the cords affect how well the vocal cords can vibrate during phonation. Nodules result in the cords incompletely closing during phonation so patients’ voices often sound airy or breathy and pitch breaks are common. Singers may notice their upper register is erratic or absent.
Vocal cord nodules can occur in all age groups affecting both men and women. They appear more commonly in young boys before puberty, but beginning during the teenage years, nodules are far more common in women. Persons most affected or susceptible to develop nodules talk a lot or have vocally demanding jobs.
Like many voice disorders, nodules are best diagnosed by an experienced ENT who can perform a laryngoscopy or stroboscopy to directly look at the vocal cords. This is a simple and painless in-office procedure. Of note, it’s worth mentioning that many vocal cord masses are incorrectly labeled as “nodules.” It’s important to be evaluated by experienced ENTs who understand vocal lesions to make the correct diagnosis and ensure nodules are not mistaken for other common problems like cysts or polyps that are distinctly different.
Recommended treatment of vocal nodules is typically voice therapy and rarely requires surgery. Voice therapists help identify the underlying behavioral problems that created the nodules in the first place. By modifying how one uses their voice and creating healthy vocal habits, nodules usually resolve on their own.
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- Caused by repetitive overuse of the voice
- Often referred to as “singer’s nodules”
- Most common in women between the ages of 20 and 50 years
- Appear as calluses under a microscope
- Can affect both men and women
Vocal misuse or overuse can result in vocal cord nodules or small bumps on each side of the vocal cords. Nodules don’t allow the cords to fully come together and vibrate normally. Patients with nodules have voice cracks or pitch breaks when talking or singing.
Polyps
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- Caused by misuse/overuse of the voice
- Appear as red blisters of varying shape and size
- Can affect one or both vocal cords
- Generally larger than nodules
- Is often caused by vocal cord abuse such as shouting, singing, and excessive talking
- May also be attributed to smoking, allergies, sinusitis, and in rare cases hypothyroidism
This patient has hoarseness due to a polyp on his left vocal cord. You can see how it impairs vibration while he is talking.
The same patient seen a few weeks after the left vocal cord polyp was surgically removed. Normal vibration of the cords has been restored and his voice is back to normal.
Cysts
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- Fluid filled sac with a semi solid center
- Present as mucus retention cysts or sebaceous cysts
- Less common than nodules or polyps
- Result of injury to the vocal cord
This patient has hoarseness due to a left vocal fold mass under the surface of the cord. You can see it affects the vibration and closure of the vocal folds when she is talking. The mass is a benign cyst.
This video shows the same patient a few weeks after surgical microflap excision of the left vocal fold cyst. Normal vocal fold closure and vibration have been restored, and her voice is back to normal.
Dr. King is a lead surgeon in endoscopic microsurgical procedures to correct and remove vocal cord lesions. Working in conjunction with a team of vocal therapists, Peak ENT leads the field in comprehensive and effective vocal cord care.
