Voice Disorders - Vocal Nodules, Polyps, Cysts and Tumours

The most common vocal fold growths are nodules, polyps and cysts.

• Vocal fold nodules – thickened areas that occur on both vocal folds. Also known as singer’s nodules or ‘calluses of the vocal fold'.
• Vocal fold polyp – a growth that is typically present on only one vocal fold.
• Vocal fold cyst – fluid-containing sac located under the surface of the vocal fold.

• Hoarse voice
• Low pitch
• Vocal fatigue
• Airy or breathy voice
• Inability to sing high-pitched notes
• Increased effort to speak or sing
• Frequent throat clearing

• Nodules and polyps are usually due to repetitive trauma to the vocal folds e.g. due to frequent yelling or voice overuse.
• Reflux of acid from the stomach into the larynx (laryngopharyngeal reflux) and chronic exposure to irritants such as cigarette smoke may also contribute to formation of nodules and polyps.
• Cysts may occur on their own due to blockage of a mucous gland under the surface of the vocal fold Tumours of the vocal folds can also cause voice problems.
• Tumours are most commonly caused by smoking and alcohol.

Diagnosis is made by taking a history of the voice problem and by physical examination. Your specialist may pass a nasoendoscope through the nose down to the voice box under local anaesthesia.

A more detailed examination is sometimes needed using videostroboscopy. In this procedure, a rigid telescope tube with a stroboscopic light is passed through the mouth (after spraying the throat with anaesthetic) to view the voice box.

Other medical conditions that can contribute to the voice problem such as acid reflux, allergic rhinitis (sensitive nose) and sinusitis may need to be evaluated separately.

Treatment includes voice rest, management of aggravating factors (e.g. acid reflux and allergic rhinitis), and sometimes voice therapy with a speech therapist. Many benign vocal fold growths resolve with conservative management. If the growth persists or there is doubt about its nature, then phono-microsurgery may be advocated.

Phono-microsurgery is surgery to the vocal fold using microsurgical techniques and instruments, and sometimes lasers. This surgery may be recommended to improve the voice or remove a growth for laboratory analysis. If a lesion proves to be cancerous, further treatment will be required.