Diagnosis of Vocal Fold Nodules, Polyps and Cysts
How is the diagnosis of a benign vocal fold lesion made?
A history of how the voice problem started and an evaluation of
speaking method are important steps in the diagnosis of benign vocal
fold lesions.
Stroboscopy With Rigid Laryngoscope Is Key to Diagnosis
Careful examination of the vocal folds is essential for making the
diagnosis of a benign vocal fold lesion. Examination is typically
performed using a rigid laryngoscope with a stroboscopic light source. (For more information, see Laryngoscopy/Stroboscopy.)
- Rigid
laryngoscopy provides an optimal, magnified view of the vocal fold
surface, allowing the detection of most surface lesions.
- Stroboscopy
allows the examiner to assess the mucosal wave as a marker for vocal
fold vibration. Assessment of mucosal wave alterations gives insight
into the effects of the benign vocal fold lesion on vocal fold
vibration.
- Sometimes, a trial of voice rest and/or voice
therapy may be instituted, after which changes on the vocal fold lesion
are assessed. Vocal nodules tend to resolve partially or almost
completely with voice therapy and/or voice rest, while vocal fold cysts
and polyps do not.
Investigation for Other Associated Abnormalities
The diagnostic process should also focus on looking for important associated factors, such as:
- Reflux
- Allergies
- Side effects of medications (e.g., diuretics and antihistamines)
- Hormonal imbalance(s)
Accurate Diagnosis Key to Correct Treatment Strategy
The subtle variations among vocal nodules, polyps, and cysts make
accurate diagnosis a challenge – especially when swelling is also
present.
- Because most otolaryngologists treat vocal fold
nodules with voice therapy and rest, but treat vocal fold cysts or
polyps with surgery, the importance of making an accurate diagnosis
cannot be overemphasized.
- For example, if a patient is
given an incorrect diagnosis of vocal fold nodules but actually has a
vocal fold cyst on one vocal fold and a reactive lesion on the other,
voice therapy will be suggested, the patient will most likely not see
adequate improvement in the voice, and surgery will be delayed.
Phonomicrosurgery Advances Provide Benefit, Even to Singers
There is a widely held but erroneous belief in the singing community
that a singer should never have surgery on the vocal fold because
singing will not be possible after surgery. This is incorrect as a
global statement. Phonomicrosurgery for benign vocal fold lesions is
highly successful, such that a very high percentage of patients resume
all their prior vocal activities, including singing.
Vocal Fold Scar May Co-exist With Vocal Fold Lesions – A Much Bigger Challenge
Often vocal fold scar tissue is associated with vocal fold lesions
but will not be noticed during the initial examination. The failure to
observe vocal fold scarring is often due to one of two factors.
- Prominence of the vocal fold lesion(s)
- Difficulty
in fully assessing the nature and severity of the vocal fold scar due
to poor vocal fold vibration and function resulting from the vocal fold
lesion(s)
Often the full extent of the vocal fold scarring associated with
benign vocal fold lesions cannot be completely appreciated until the
vocal folds are examined during microlaryngoscopy at the time of
surgery.
- The finding of vocal fold scarring is
important given that scarring may affect both choice of treatment and
the success of surgery for vocal fold lesions.
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