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Understanding Vocal Fold Nodules, Polyps and Cysts
Vocal fold lesions refer to a group of benign, abnormal growths
(lesions) within or along the covering of the vocal fold. Vocal fold
lesions are one of the most common causes of voice problems.
The most common non-cancerous lesions of the vocal folds include:
- Vocal fold nodules
- Vocal fold polyps
- Vocal fold cysts
Vocal Fold Nodules (also called Singer's Nodes, Screamer's Nodes)
- Vocal fold nodules are typically present on both vocal folds.
- They usually face each other.
- They are typically located at the midpoint of the membranous part of the vocal fold.
- These
lesions are thought of as the "calluses of the vocal fold." Analogous
to calluses, these lesions diminish or disappear when the trauma/misuse
of the vocal folds is stopped.
- When analyzed under the
microscope, nodules have a thickened surface layer of the vocal fold
(thickened epithelium) and a thickened superficial lamina propria.
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Two Types of Vocal Fold Nodule
Many laryngologists consider the "age" of the vocal fold nodule when deciding upon treatment.
- Soft or young nodules most likely resolve on their own; hence voice therapy, not surgery, is typically indicated.
- Hard or old nodules generally require surgical removal.
Association with "Extroverts"
Vocal fold nodules are common among children (more common in boys)
and are also seen in young adult females. Individuals with vocal fold
nodules usually are extroverts and may have a loud voice, which can
often be particularly percussive.
A vocal fold polyp typically occurs only on one side of the vocal
fold. Although there may be some similarities between polyps and
nodules, they look different when examined under the microscope. Polyps
are typically more reddish, due to increased blood vessel supply (vasculature).
A vocal fold polyp can occur in a variety of shapes and sizes.
Depending upon the nature of the polyp, it can cause a wide range of
voice disturbances.
Vocal Fold Polyp
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A vocal fold cyst is a firm mass of organized material contained
within a membrane (sac). The cyst can be located near the surface of
the vocal fold or deeper, near the ligament of the vocal fold. (For more information, see Anatomy & Physiology of Voice Production.)
As with vocal fold polyps and nodules, the size and location of
vocal fold cysts affect the degree of disruption of vocal fold
vibration and subsequently the severity of hoarseness or vother oice
problem.
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Surgery is the most commonly recommended treatment for vocal fold
cysts that significantly alter and/or limit voice. Voice therapy
following surgery is typically recommended to maximize vocal recovery
after surgery and prevent a recurrent lesion. (For more information, see Phonomicrosurgery.)
Reactive Vocal Fold Lesion
A reactive vocal fold lesion is a mass located opposite another
vocal fold lesion, such as a vocal fold cyst or polyp. The reactive
vocal fold lesion is thought to be a callus or reaction from trauma or
repeated injury from the lesion on the opposite vocal fold. There are
two distinguishing features of a reactive vocal fold lesion versus
other vocal fold lesions.
- There will be minimal to no disruption of the vocal fold vibratory behavior on the side with a reactive vocal fold lesion.
- When
a reactive vocal fold lesion is treated by voice rest and therapy, it
typically will get smaller or completely disappear, while a vocal fold
cyst or polyp will not.
Reactive Vocal Fold Lesion
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What are the causes of benign vocal fold lesions?
The exact cause or causes of benign vocal fold lesions is not known.
Lesions are thought to arise following "heavy" or traumatic use of the
voice, including voice misuse such as speaking in an improper pitch,
speaking excessively, or screaming or yelling.
The formation of vocal fold lesions can also be related to voice use
during throat infection such as the common cold. For example, singers
who "sing sick" may subsequently develop a benign lesion of the vocal
fold. The increased sensitivity of the lining and structure of the
vocal folds during the illness may result in the formation of a benign
vocal fold lesion. (For more information, see Laryngitis.)
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