Vocal Cord Cysts and Polyps

What are vocal cord cysts and polyps?
Vocal cord cysts and polyps also referred as vocal fold lesions are non-cancerous, benign (localised) abnormal growth on the vocal cord.  Vocal cord lesions are primarily divided into three types: nodules, polyps and cysts. They are particularly common among people using voice as part of their profession for instance hawkers, singers etc.  Pulp polyp and cysts may attribute to voice disorders.

  
What causes vocal cord cysts and polyps?
Although vocal cysts and polyps remains an idiopathic (cause unknown) disease, some evidences have linked the cause with the vocal abuse. A heavy traumatic use of the vocal cord, like shouting or yelling, speaking loudly, and coaching, high pitch voice may lead to this clinical condition. Other factors involved are certain kind of allergies, alcoholism, smoking, muscle tension, caffeine intake etc.

What are the symptoms or manifestations of vocal cysts and polyps?
The symptoms of vocal cysts and polyps include loss of voice pitch, hoarseness, breaking of voice, frequent throat clearing, delay in voice initiation, raspy voice and fatigue of the voice.

Vocal cord polyps
A vocal cord polyp is commonly found on one vocal cord (unilateral), but it may develop on both cords. They often resemble blisters and have a characteristic red colour due to surface dominated by blood vessels. They frequently result from an initiating acute phonatory injury. Their effects on the voice are wide-ranging, depending on the type of polyp.  Most polyps must be surgically removed to restore a normal voice. A distinct type of vocal cord polyp known as Rinke’s edema or polypoid corditis is found in patients with smoking habit.

Vocal cord cysts
A vocal cord cyst is a tissue mass, localized within the vocal cord membrane. It can be seen both on the surface or deeper into the segment.  Vocal cord cysts are differentiated into: epidermoid cysts and mucus retention cysts. The size and location of vocal cord cysts has a linear impact on the extent of the disruption of vocal cord vibration and the severity of the voice problem or hoarseness in the patient.

How are vocal cysts and polyps diagnosed?
The diagnosis is based on the history of the voice issue or complication narrated by the patient, following which a thorough examination is performed by the otolaryngologist.  The vocal cords are also evaluated for any underlying medical conditions that may affect the voice (e.g., reflux laryngitis, allergic rhinitis).Diagnostic procedures like laryngoscopy having a stroboscopic light source are employed to examine the vocal cords. In this procedure, a telescope-tube is approached through the mouth of the patient until the vocal cords allowing the doctor to assess the voice box. The images can be recorded on video.

What is the treatment for vocal cysts and polyps?
The management approach can be both medical and surgical depending upon the severity of the case. The patient may be placed on voice rest, voice therapy. In a typical management plan, a patient can be scheduled a period of vocal rest with steroid treatment.

Surgical intervention is generally given to those patients, in which the speech therapy and medical treatments do not show progress. Phonomicrosurgery is the type of surgery done to treat vocal cord abnormalities. The patient is anesthetized, and the airway is secured by high-pressure jet ventilation through the laryngoscope, endotracheal intubation, or, for an inadequate upper airway, tracheotomy.  Surgery with subsequent by voice therapy is the gold standard treatment for vocal cord cysts.