Vocal Cord Polyp
A benign growth on the vocal cords that develops from voice trauma or irritation, causing persistent hoarseness and voice changes
Quick Facts
- Type: Benign Lesion
- ICD-10: J38.1
- Location: Vocal cords
- Treatment: Voice therapy/Surgery
Overview
Vocal cord polyps are benign (non-cancerous) growths that develop on one or both vocal cords, the bands of muscle tissue in the larynx (voice box) that vibrate to produce sound. These fluid-filled or gelatinous lesions typically form along the free edge of the vocal cord where mechanical stress is greatest during phonation. Unlike vocal nodules, which are usually bilateral and more fibrous, polyps are often unilateral and have a softer, more fluid-filled consistency.
Polyps can vary significantly in size, from small lesions barely visible during examination to large masses that can obstruct the airway. They may be sessile (broad-based) or pedunculated (attached by a stalk), and their appearance can range from translucent to reddish, depending on their vascular content. The condition is one of the most common causes of hoarseness in adults and can significantly impact voice quality, particularly in professional voice users such as teachers, singers, and public speakers.
While vocal cord polyps are benign and not life-threatening, they can cause considerable discomfort and functional impairment. The primary symptom is persistent hoarseness, but patients may also experience voice fatigue, reduced vocal range, and the sensation of something in the throat. Treatment approaches range from conservative voice therapy to surgical removal, depending on the size of the polyp, severity of symptoms, and patient's vocal demands. Early intervention often leads to better outcomes and can prevent the need for more invasive treatments.
Symptoms
Vocal cord polyps produce various symptoms related to voice production and throat sensation. The severity depends on the polyp's size, location, and whether one or both vocal cords are affected.
Primary Voice Symptoms
Additional Symptoms
- Sore throat - Mild discomfort from voice strain
- Voice fatigue - Voice tires quickly with use
- Breathy voice quality
- Reduced vocal range (especially high notes)
- Voice breaks or sudden voice loss
- Throat clearing or coughing
- Sensation of lump in throat (globus)
- Difficulty projecting voice
Severity Indicators
- Mild: Occasional hoarseness, minimal impact on daily activities
- Moderate: Persistent hoarseness, voice fatigue with normal use
- Severe: Significant voice limitation, difficulty being heard, possible airway symptoms
Red Flag Symptoms
Seek immediate evaluation for:
- Difficulty breathing or stridor (noisy breathing)
- Complete voice loss lasting more than 2 weeks
- Blood in saliva or when coughing
- Difficulty swallowing
- Unexplained weight loss
- Neck mass or swollen lymph nodes
- Pain radiating to the ear
Causes
Vocal cord polyps typically develop from acute or chronic trauma to the vocal cords, often combined with irritating factors that prevent normal healing.
Primary Causes
Vocal Trauma
- Acute phonotrauma: Single episode of voice abuse (yelling, screaming)
- Chronic voice misuse: Prolonged loud talking, improper singing technique
- Hard vocal attack: Forceful initiation of voicing
- Excessive coughing: Chronic cough from various causes
- Intubation injury: Trauma during medical procedures
Contributing Factors
Irritants
- Smoking: Primary irritant causing inflammation
- Alcohol: Dries and irritates vocal cords
- Environmental irritants: Dust, chemicals, pollutants
- Allergies: Chronic postnasal drip and throat clearing
- Acid reflux (GERD): Stomach acid irritating vocal cords
Medical Conditions
- Upper respiratory infections: Laryngitis with voice use
- Thyroid disorders: Hypothyroidism affecting tissue
- Hormonal changes: Pregnancy, menstruation
- Bleeding disorders: Increased hemorrhage risk
- Chronic sinusitis: Postnasal drip irritation
Pathophysiology
Polyp formation process:
- Initial vocal cord trauma causes blood vessel rupture
- Bleeding into the superficial layer (Reinke's space)
- Inflammatory response and edema formation
- Organization of fluid/blood into polyp structure
- Continued trauma prevents resolution
- Polyp may become fibrotic over time
Occupational Factors
- Teachers and educators
- Singers and performers
- Coaches and fitness instructors
- Salespeople and customer service
- Clergy and public speakers
- Factory workers in noisy environments
Risk Factors
Several factors increase the likelihood of developing vocal cord polyps:
Behavioral Risk Factors
- Voice overuse: Extended periods of talking or singing
- Loud voice use: Habitual shouting or loud speaking
- Poor vocal technique: Improper breathing or voice placement
- Smoking: Current or past tobacco use
- Alcohol consumption: Regular or excessive drinking
- Throat clearing: Habitual clearing or coughing
Medical Risk Factors
- Gastroesophageal reflux disease (GERD)
- Chronic allergies or sinusitis
- Asthma requiring inhaled medications
- Hypothyroidism
- Blood clotting disorders
- Recent upper respiratory infection
- Use of blood thinners
Occupational Hazards
- Professional voice use requirements
- Working in noisy environments
- Exposure to airborne irritants
- Jobs requiring phone use
- Teaching or coaching positions
- Performance careers
Demographic Factors
- Age: Most common in adults 20-50 years
- Gender: Slightly more common in men
- Personality: Type A, talkative individuals
- Stress levels: High stress increases muscle tension
Diagnosis
Accurate diagnosis of vocal cord polyps requires specialized examination by an otolaryngologist (ENT doctor) or laryngologist using visualization techniques.
Clinical Evaluation
Medical History
- Voice symptom timeline and progression
- Voice use patterns and demands
- Acute voice trauma episodes
- Smoking and alcohol history
- Medical conditions and medications
- Previous voice problems or treatments
- Occupational voice requirements
Voice Assessment
- Perceptual evaluation: GRBAS scale (Grade, Roughness, Breathiness, Asthenia, Strain)
- Maximum phonation time: Ability to sustain vowels
- Voice range profile: Pitch and loudness capabilities
- Voice handicap index: Impact on quality of life
Laryngeal Examination
Indirect Laryngoscopy
- Mirror examination (limited view)
- Basic visualization of vocal cords
- Initial screening tool
Flexible Laryngoscopy
- Fiberoptic scope through nose
- Real-time vocal cord visualization
- Assessment during speech and singing
- Evaluation of other laryngeal structures
Videostroboscopy
- Gold standard for vocal cord lesions
- Slow-motion view of vocal cord vibration
- Assesses mucosal wave and closure
- Determines polyp impact on function
- Guides treatment decisions
Additional Testing
- Acoustic analysis: Computer voice measurements
- Aerodynamic assessment: Airflow and pressure
- Imaging: CT or MRI for complex cases
- Biopsy: If malignancy suspected
- pH monitoring: To assess reflux contribution
Differential Diagnosis
- Vocal cord nodules
- Vocal cord cyst
- Reinke's edema
- Laryngeal papillomatosis
- Vocal cord paralysis
- Laryngeal cancer
- Granuloma
Treatment Options
Treatment for vocal cord polyps depends on polyp size, symptoms severity, vocal demands, and response to conservative management.
Conservative Management
Voice Therapy
- Voice rest: Complete or modified based on severity
- Vocal hygiene education: Proper voice use techniques
- Resonant voice therapy: Reduces vocal cord impact
- Breathing exercises: Improves breath support
- Laryngeal massage: Reduces muscle tension
- Humming exercises: Gentle vocal cord vibration
Medical Management
- Anti-reflux medications: PPIs if GERD present
- Corticosteroids: May reduce inflammation (limited use)
- Allergy management: Antihistamines, nasal steroids
- Hydration therapy: Systemic and surface hydration
- Mucolytics: Thin secretions
- Antibiotics: Only if secondary infection
Surgical Treatment
Microlaryngoscopy
- Direct visualization under general anesthesia
- Microscopic precision for polyp removal
- Preservation of normal vocal cord tissue
- Cold instrument or laser techniques
- Usually outpatient procedure
- Voice rest required post-operatively
Office-Based Procedures
- KTP laser: For small, vascular polyps
- Injection laryngoplasty: For associated gaps
- Performed under local anesthesia
- Immediate return to limited voice use
Post-Treatment Care
Immediate Post-Operative
- Complete voice rest: 3-7 days typically
- Hydration: 64+ oz water daily
- Humidification: Steam inhalation
- Avoid irritants: No smoking, alcohol
- Reflux precautions: Elevate head, dietary changes
Voice Rehabilitation
- Gradual voice return protocol
- Post-operative voice therapy
- Regular follow-up examinations
- Technique modification for professional voice users
- Long-term vocal hygiene maintenance
Treatment Outcomes
- Voice therapy alone: 50-60% improvement in small polyps
- Surgery: 90%+ voice improvement
- Recurrence rate: 5-15% with proper technique
- Professional voice users: May need specialized rehabilitation
Prevention
Preventing vocal cord polyps focuses on proper voice use, avoiding irritants, and maintaining overall vocal health:
Vocal Hygiene
- Stay hydrated: Drink 6-8 glasses of water daily
- Avoid vocal abuse: No yelling, screaming, or loud talking
- Use amplification: Microphones when speaking to groups
- Warm up voice: Gentle exercises before extensive use
- Take voice breaks: Rest periods during heavy voice use
- Speak at comfortable pitch: Avoid artificially low voice
Environmental Modifications
- Maintain indoor humidity (40-50%)
- Avoid smoky or dusty environments
- Limit exposure to chemical irritants
- Use proper ventilation systems
- Consider air purifiers for allergies
Lifestyle Changes
- Quit smoking: Primary prevention measure
- Limit alcohol: Especially avoid before voice use
- Manage reflux: Diet modifications, medications
- Control allergies: Reduce postnasal drip
- Reduce caffeine: Can be dehydrating
- Get adequate sleep: Vocal cord recovery
Professional Voice Users
- Regular voice training/coaching
- Learn proper breath support
- Develop efficient voice techniques
- Schedule regular voice evaluations
- Plan voice use around performances
- Consider career-specific modifications
When to See a Doctor
Early evaluation of voice changes can lead to better outcomes and prevent progression:
See an ENT Specialist For
- Hoarseness lasting more than 2 weeks
- Voice changes without obvious cause
- Pain when speaking or swallowing
- Frequent voice loss episodes
- Decreased voice range or volume
- Voice fatigue interfering with work
- Throat discomfort with voice use
Urgent Evaluation Needed
- Difficulty breathing or noisy breathing
- Coughing up blood
- Severe throat pain
- Inability to swallow
- Neck mass or swelling
- Complete voice loss with fever
Professional Voice Users
Seek evaluation sooner if you are:
- Singer or performer
- Teacher or instructor
- Salesperson or call center worker
- Attorney or clergy
- Anyone whose livelihood depends on voice
Frequently Asked Questions
Small, recent polyps may resolve with voice rest and therapy, but most established polyps require treatment. Early intervention with voice therapy can sometimes prevent the need for surgery, but polyps rarely disappear completely without treatment.
Initial voice rest is typically 3-7 days, followed by gradual voice return over 2-4 weeks. Complete healing takes 6-8 weeks. Professional voice users may need 2-3 months of rehabilitation before returning to full voice use.
Recurrence rates are 5-15% when proper surgical technique is used and voice therapy follows. Recurrence is more likely if underlying causes (smoking, voice abuse, reflux) aren't addressed.
No, vocal cord polyps are benign (non-cancerous) growths. However, any vocal cord lesion should be properly evaluated to rule out malignancy, especially in smokers or those with persistent hoarseness.
Professional singing should be avoided until the polyp is treated, as continued voice use can worsen the condition. Some singers may need to modify technique permanently to prevent recurrence. Work with a voice therapist familiar with singers.
References
- Martins RH, Defaveri J, Domingues MA, de Albuquerque e Silva R. Vocal polyps: clinical, morphological, and immunohistochemical aspects. J Voice. 2011;25(1):98-106.
- Johns MM. Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. Curr Opin Otolaryngol Head Neck Surg. 2003;11(6):456-461.
- Sulica L. Laryngoscopy, stroboscopy and other tools for the evaluation of voice disorders. Otolaryngol Clin North Am. 2013;46(1):21-30.
- Zeitels SM, Hillman RE, Desloge R, et al. Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions. Ann Otol Rhinol Laryngol Suppl. 2002;190:21-40.
- American Academy of Otolaryngology-Head and Neck Surgery. Clinical Practice Guideline: Hoarseness (Dysphonia). Otolaryngol Head Neck Surg. 2018;158(1_suppl):S1-S42.