Voice Disorders

Figure 1: A typical polyp: a red, well-demarcated mid-vocal fold mass.

Figure 2: A polyp can interfere with the closure of the vocal folds.

Figure 3: A longstanding polyp has become very oddly shaped. There are enlarged blood vessels on both vocal folds.

What is a polyp?

A polyp is a specific and clearly demarcated mass (“mass” simply means “lump,” and does not imply cancer or precancerous lesion) usually found at the midpoint the vocal cord. This typical location suggests that polyps are the result of phonotrauma, the physical stresses on the vocal fold which occur with heavy voice use or voice use under adverse circumstances. Some believe that polyps are formed by localized bleeding of the small blood vessels of the vocal folds when they are ruptured by shear forces.

Figure 1: A typical polyp: a red, well-demarcated mid-vocal fold mass.

Different from a polyp in other parts of the body, a vocal fold polyp is not a precancerous or cancerous lesion. It should be noted, though, that a benign lesion cannot always be distinguished from a malignant one by an examination in the office – in such a case, a biopsy may be necessary.

The term ‘polyp’ is sometimes used to refer to any mass of the vocal folds, even by otolaryngologists . In addition to being imprecise, this can lead to confusion and errors in treatment and should be avoided.

What are the symptoms of a polyp?

Polyps generally cause painless hoarseness. The hoarseness results from irregularities in vocal fold closure as well as irregularities in vibration, both the result of the bulk of the polyp. If the polyp has a narrow attachment to the vocal cord, like the neck of a balloon, it may flip in and out of the area of vocal cord closure, and produce only intermittent voice breaks. In some cases, the voice change may be accompanied by a sensation of a foreign body at the level of the vocal folds, or a feeling of wanting to clear the throat.

Figure 2: A polyp can interfere with the closure of the vocal folds.
Figure 2: A polyp can interfere with the closure of the vocal folds.

What does a polyp look like?

A polyp is usually a red or reddish lesion that has a sharp margin and is clearly different from surrounding tissue. It can be either broad-based or narrow-necked. It may be smooth and round, or it may have lobes. Some polyps that have been present for a long time can take on odd shapes. There is a lot of variability in size. Polyps may occur singly or in pairs, one on each vocal fold directly opposite one another. Almost always, they occur at the midpoint of the vocal fold.

Figure 3: A longstanding polyp has become very oddly shaped.
There are enlarged blood vessels on both vocal folds.
Figure 3: A longstanding polyp has become very oddly shaped. There are enlarged blood vessels on both vocal folds.

The mid-fold location is so characteristic for a polyp that a mass
occurring somewhere else on the vocal folds should be examined
very carefully before settling on a diagnosis of polyp.

Polyps do not generally grow over the short-term, although there are exceptions. These exceptions are probably due to repeated trauma, which the initial polyp makes more likely. The propensity for a polyp (or any mid-vocal fold lesion) to cause additional trauma is an argument in favor of its treatment, in addition to its effect on the voice. Any lesion that enlarges rapidly (over weeks) is unlikely to be a polyp and should be considered for removal.

How is a polyp treated?

Voice rest, often prescribed in cases of hoarseness, may improve the voice somewhat, but is not likely to make a polyp go away. Voice rest serves soften and dissolve associated swelling, but the polyp itself is generally too firm and bulky to shrink significantly. People with masses on the vocal fold may find themselves entirely without voice after cheering at a game, or an evening out with friends. Voice rest can help them regain their baseline voice, but the situation will repeat the next time the voice is used strenuously unless the underlying problem is fixed.

Since a polyp is likely a result of phonotrauma, voice therapy is almost always a good idea in order to make the person aware of circumstances and habits of voice use that may have led to the formation of the polyp in the first place. In the case of a small lesion, especially if it has not been present a long time, voice therapy by itself may be enough to minimize the effect of the polyp and restore good voice.

Figure 4: Microscopic removal of a polyp
before after
Figure 4: Microscopic removal of a polyp

More often than not, polyps require microlaryngoscopic surgery to be removed. Whether an individual should take this step depends on the level of vocal disability, the potential for future damage and the certainty of the diagnosis. Although there is little evidence to support the use of voice therapy in conjunction with surgery, most laryngologists feel that it is advisable in order to attain the best outcome and reduce the chances of forming another polyp by continuing the voice habits that led to the first one. The chances of forming another polyp are extremely low after surgery and voice therapy.

Cyst

Polyp

Reflux

Cancer

Tremor

Nodules

Papilloma

Laryngitis

Granuloma

Aging Voice

Hemorrhage

Sulcus Vocalis

Vocal Fold Scar

Reinke’s Edema

Vocal Fold Paralysis

Spasmodic Dysphonia

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