Treatment of Vocal Fold Nodules, Polyps and Cysts

Key Glossary Terms

Vocal Fold Lesions
Specific to this chapter; refers to vocal nodules, vocal polyps, and vocal cysts

Vocal Abuse
Normal vocal behaviors used in excess, leading to vocal fold injury (e.g., excessive loudness or cough)

Vocal Misuse
Abnormal vocal behaviors that cause stress or injury to the vocal folds (e.g., excess tension while speaking)

Vocal Overuse
Normal voice behavior that takes its toll with time (e.g., singer after many years of performing)

Glossary

All treatments should be aimed at a functional goal.

• Treatment should be reserved for patients with functional limitations of their voice (e.g., voice loss, vocal fatigue, change or limitation in singing voice, etc.) who thus have the motivation to improve their voice.
• If no significant functional limitation exists, then most likely the patient will not be motivated or successful at proceeding with any type of treatment at all.
• Often, when a patient notes mild hoarseness but no significant functional limitations or abnormalities, he or she only wants to know if the hoarseness is due to a cancer. If the hoarseness is due to a benign vocal fold lesion, then pursuing no treatment at all is a reasonable approach.

There is no indication for treatment with any type of steroid medication – inhaled steroids, steroid pills, or shots – for benign vocal fold lesions. (However, a short course of steroid pills can be used to reduce swelling thus allowing a better assessment of the size and nature of vocal fold lesions). In addition, given that benign vocal fold lesions are not an infectious process, antibiotics or antifungal medications are not used for this condition.

The most common treatment options for benign vocal fold lesions include:

• Reduced amounts of voice use (modified voice rest)
• Voice therapy
• Singing voice therapy
• Phonomicrosurgery (For more information, see Phonomicrosurgery.)

The decision on which treatment to use and in which sequence to proceed is highly complex and should be decided jointly by the laryngologist and patient, based on the individual case.

The key question to address regarding treatment for benign vocal fold lesions, especially surgery, is the degree of limitation of the voice following each different type of treatment and the exact voice demands of the patient. For example, if a singer develops benign vocal fold lesions and undergoes voice therapy, that improves speaking but not singing voice, then surgery might be the best option to restore singing voice.

According to current best practices, there is no role for a type of surgery called "vocal cord/vocal fold stripping" for the treatment of benign vocal fold lesions.