Vocal cord nodules, polyps, and cysts are benign (non-cancerous) growths that occur along the free edges or just below the surface membrane of the vocal cord(s). Because they typically distort the normally straight contour of the vocal cords, they impair how well the vocal cords close during speaking and/or singing. A patient with one of these lesions may have a gap in between the vocal cords during certain phases of vibration, when there should ideally be none. This results in a leaking vocal valve, which is why patients with nodules, polyps or cysts often suffer from vocal fatigue. Singers, in particular, may find that they have difficulty reaching their high notes, especially when singing softly.

It is also common for nodules, polyps and cysts to cause a raspy voice. In addition to impacting vocal cord closure, these lesions can stiffen the vocal cord(s). Vocal cords that are not soft cannot vibrate optimally, and this can lead to a raspy, strained or inconsistent sound.

  • Nodules - In general, vocal cord nodules are comprised of firm scar tissue (like a callous) and occur in pairs on opposing sections of each of the vocal cords.  
  • Polyps - Vocal cord polyps tend to be softer, more gelatinous structures than nodules and they commonly protrude more from the free edge. They typically exist only along one vocal cord, although a reactive nodule may form at its contact point with the opposite vocal cord. This results from collision trauma of the polyp against the other vocal cord during sound production. Polyps can also exist along both vocal cords (bilaterally), and sometimes occur in the context of a leaking blood vessel (hemorrhage) within the vocal cord, resulting in a hemorrhagic polyp.
  • Cysts - Vocal cord cysts are spherical or ovoid structures that tend to be located slightly deeper within the vocal cord than nodules or polyps. They can be solid (keratin cyst) or filled with fluid (mucus retention cyst). Some patients may be born with a vocal cord cyst(s) (congenital cyst), but they are more commonly acquired.

Treatment

Vocal cord nodules, and often vocal cord polyps, tend to occur in individuals with significant vocal demands (singers, teachers, etc.) but can also occur in patients who are vocal over-doers. It is optimal for patients with these types of lesions to work with a voice pathologust, a speech pathologist skilled in treating voice disorders, to assess whether voice use patterns are contributing to the development of the problem. Our Voice Center provides a collaborative and multidisciplinary working environment between the patient, the laryngologist and the voice pathologist.

For many patients, minimally invasive laryngeal surgery can be an effective and safe treatment for these lesions. Optimal voice outcomes are most reliably achieved by a laryngologist/laryngeal surgeon who has specialized equipment, training and experience operating on the delicate vocal cords.

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