Vocal Cord Lesions (Nodules, Polyps, and Cysts)
Vocal cord lesions are benign growths. They can include nodules, polyps, and cysts. Vocal trauma or overuse is associated with vocal cord lesions.
Vocal cord nodule
What are vocal cord lesions?
Vocal cord lesions, also known as vocal fold lesions, are benign (noncancerous) growths that include nodules, polyps, and cysts. All can cause hoarseness and are typically associated with vocal overuse or vocal cord trauma.
Vocal cord nodules, sometimes called singer’s nodules or nodes, result from repetitive overuse or misuse of the voice. These callous-like growths develop in the midpoint of the vocal folds. Vocal cord nodules look like calluses under the microscope and are occasionally associated with abnormal blood vessels. Women between the ages of 20 and 50 years old are more prone to vocal cord nodules, but both men and women can be affected.
Vocal cord polyp
Vocal cord polyps are different from nodules because they can occur on either one or both vocal cords. They tend to be more vascularized than nodules, meaning they have more blood vessels and appear reddish in color. These growths can vary in size and shape, but are usually larger than nodules and resemble blisters. Like vocal cord nodules, polyps can be caused by overuse or misuse of the voice, but can also be caused by a single episode of vocal abuse (such as yelling at a sports event). Another type of vocal cord polyp, polypoid corditis (Rienke’s edema), is associated almost exclusively with smoking.
Both vocal cord nodules and polyps can be caused by different forms of trauma, including singing (particularly in professional singers), screaming, cheerleading, and excessive talking (such as that by a teacher, coach, salesperson or radio personality). Other causes include extra muscle tension when speaking, smoking, alcohol use, sinusitis, allergies, and rarely, hypothyroidism.
Vocal cord cyst
Vocal cord cysts are growths that have a sac around a fluid-filled or semisolid center. These are less common than vocal cord nodules and polyps. There are 2 types of vocal cord cysts, mucus retention cysts and epidermoid (or sebaceous) cysts.
Vocal cord lesions also can be caused by using the voice while one is sick with an upper respiratory infection or laryngitis.
What are the symptoms of vocal cord lesions?
Vocal cord lesions can result in hoarseness, breathiness, multiple tones, loss of vocal range, vocal fatigue or loss of voice.
Patients with vocal cord nodules or polyps may describe their voice as harsh, raspy, or scratchy. There may be frequent voice breaks, easy vocal fatigue with use or there may be a decreased range of vocal sounds. Pain is another symptom that is felt as a shooting pain from ear to ear, general neck pain or as a lump in the throat. Patients may also experience frequent coughing, throat clearing, or general fatigue.
Here are a few singers who have had to undergo surgery as a result of this:
Adele: Vocal hemorrhage, canceled a tour, had surgery.
Julie Andrews: Throat nodules, and reportedly, further damage due to surgery to remove them. Permanent damage ensued, ending her singing career and had a (second hemorrhage)
Björk: Vocal nodules, spent three years doing special vocal exercises, so as to avoid surgery.
Mariah Carey: Vocal nodules.
Roger Daltry (the Who): Precancerous growth.
Natalie Dessay: Vocal nodules, had surgery.
Celine Dion: Weakness in vocal cord due to a viral illness.
Lesley Feist: Unspecified vocal cord damage, took a six-month hiatus, eventually changed her singing style.
Whitney Houston: Vocal nodules.
Elton John: Vocal nodules, had surgery, his voice was noticeably deeper afterward.
Shirley Manson (Garbage): Vocal nodules.
John Mayer: Vocal granuloma, canceled tours and took a two-year break from performing, had surgery.
Freddie Mercury: Vocal nodules.
Frank Ocean: Vocal tear (or bruise).
Luciano Pavoratti: Vocal nodule, he decided to give up singing as a result, but soon recovered, and so resumed his career.
Frank Sinatra: Vocal nodules, took a month-long vow of silence.
Meagan Trainor (second hemorrhage)
Paul Stanley (Kiss): Unspecified vocal injury.
Rod Stewart: Vocal nodules.
Joss Stone: Vocal nodules.
Justin Timberlake: Vocal nodules.
Steven Tyler (Aerosmith): Burst blood vessel.
Keith Urban: Polyp, had surgery.
Beyonce: Dehydration and exhaustion, which is a whole-body health issue, and can affect vocal performance. She had to cancel some concerts while she recovered.
Stevie Nicks: Her deviated septum is sometimes credited with changing her vocal quality. However, this was a rock and roll lifestyle injury, not technically a singing injury. It was unlikely to have affected her range and agility. It might have affected her timbre, though.
Steve Zeitels Otolaryngologist at
Dr. Reena Gupta The Voice Doctor Los Angeles
Fiberoptic Laryngoscopy with Strobe
Vocal Nodules and Polyps
Your vocal folds are inside your larynx, or voice box. When you talk, air moves from your lungs through the vocal folds to your mouth. The vocal folds vibrate to produce sound. Anything that makes it harder for the vocal folds to vibrate can cause a voice problem.
Vocal fold nodules are growths that form on the vocal folds. They are benign, or not cancerous. When you use your voice the wrong way, your vocal folds may swell. Over time, the swollen spots can get harder, like a callous. These nodules can get larger and stiffer if your vocal abuse continues.
Polyps can be on one or both of the vocal folds. They may look like a swollen spot or bump, a blister, or a thin, long growth. Most polyps are bigger than nodules. You may hear them called polypoid degeneration or Reinke’s edema. It may be easiest to think of a nodule as a callous and a polyp as a blister.
Signs of Vocal Fold Nodules and Polyps
Nodules and polyps cause similar symptoms. These include:
• a “rough” voice
• a “scratchy” voice
• a harsh-sounding voice
• shooting pain from ear to ear
• feeling like you have a “lump in your throat”
• neck pain
• less ability to change your pitch
• voice and body tiredness
Causes of Vocal Fold Nodules and Polyps
Most of the time, vocal abuse or misuse causes nodules. Long-term vocal abuse can cause polyps, too. But polyps may happen after just one instance of vocal abuse, like yelling at a concert. Smoking cigarettes for a long time, thyroid problems, and reflux may also cause polyps.
Vocal abuse can happen in many ways, including from:
• tense muscles
• talking loudly
• drinking caffeine and alcohol, which dries out the throat and vocal folds
Testing for Vocal Nodules and Polyps
You should see a doctor if your voice has been hoarse for more than 2 to 3 weeks. You may want to see an otolaryngologist, or ear, nose, and throat doctor, who knows about voice problems. An SLP can test how your voice sounds. You may also see a neurologist, allergist, or other doctor, if needed.
The team will listen to how your voice sounds. They will ask you to try to change your pitch and talk louder and softer. They will want to see how long you can keep your voice going before you lose your voice. They may look into your throat to see how your vocal folds move. They can see if there are nodules or polyps on your vocal folds. They do this by putting a long tube, called an endoscope, in your mouth. A flashing light, called a stroboscope, lets the team watch your vocal folds move.
Treatments for Vocal Fold Nodules and Polyps
Treatment depends on what caused the nodules or polyps, how big they are, and what problems you have. You can have surgery to remove the nodules or polyps. This is usually done only when they are large or have been there for a long time. Children do not usually have surgery.
You need to treat any medical causes of your voice problem. You may need to have your reflux, allergies, or thyroid problems treated before the nodules or polyps will go away. You may also need medical help to stop smoking or to control stress and tension.
You may see an SLP for voice therapy. The SLP can teach you how to take care of your voice, called vocal hygiene. You can learn about how you abuse your voice and what to do to stop. Treatment may also help you change how your voice sounds or teach you how to get enough breath to talk. The SLP can also help you find ways to relax and feel less stressed.
For more information, go to: https://KenTamplinVocalAcademy.com/
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