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Treatment of Vocal Fold Nodules, Polyps and Cysts
What are the treatment options for vocal fold lesions?
All treatments should be aimed at a functional goal.
- Treatment
should be reserved for patients with functional limitations of their
voice (e.g., voice loss, vocal fatigue, change or limitation in singing
voice, etc.) who thus have the motivation to improve their voice.
- If
no significant functional limitation exists, then most likely the
patient will not be motivated or successful at proceeding with any type
of treatment at all.
- Often, when a patient notes mild
hoarseness but no significant functional limitations or abnormalities,
he or she only wants to know if the hoarseness is due to a cancer. If
the hoarseness is due to a benign vocal fold lesion, then pursuing no
treatment at all is a reasonable approach.
There is no indication for treatment with any type of steroid
medication – inhaled steroids, steroid pills, or shots – for benign
vocal fold lesions. (However, a short course of steroid pills can be
used to reduce swelling thus allowing a better assessment of the size
and nature of vocal fold lesions). In addition, given that benign vocal
fold lesions are not an infectious process, antibiotics or antifungal
medications are not used for this condition.
The most common treatment options for benign vocal fold lesions include:
- Reduced amounts of voice use (modified voice rest)
- Voice therapy
- Singing voice therapy
- Phonomicrosurgery (For more information, see Phonomicrosurgery.)
The decision on which treatment to use and in which sequence to
proceed is highly complex and should be decided jointly by the
laryngologist and patient, based on the individual case.
The key question to address regarding treatment for benign vocal
fold lesions, especially surgery, is the degree of limitation of the
voice following each different type of treatment and the exact voice
demands of the patient. For example, if a singer develops benign vocal
fold lesions and undergoes voice therapy, that improves speaking but
not singing voice, then surgery might be the best option to restore
singing voice.
No Role for "Vocal Cord/Vocal Fold Stripping"
According to current best practices, there is no role for a type of
surgery called "vocal cord/vocal fold stripping" for the treatment of
benign vocal fold lesions.
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