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LUMPS, BUMPS AND A MASS LESION ON YOUR VOCAL CORD

At the Pretoria Voice Clinic we see many patients presenting with lesions or growths on their vocal folds.                                                                              Their main presenting symptom are hoarseness or problems with their singing voice.                                                                                                              There is no concensus in the literature regarding the nomenclature of mass lesions on the vocal cords.                                                                            This It is causing a lot of confusion for patients and doctors alike.

Vocal Characteristics of School-Aged Children With and Without Attention Deficit Hyperactive Disorder.      Journal of Voice, August 2018

What lesion is this on your vocal cords?

Vocal cord nodules? or Vocal cord polyp with a secondary lesion on the other vocal cord? or Vocal cord cyst with a secondary lesion on the other vocal cord? or Bamboo nodules? or Fibrous lesion? or Granuloma? or Papilloma? 

The answer is we do not always know.

The most common lesions that we see on vocal cords are haemorrhagic polyps, vocal cord nodules which are less frequently seen and vocal cord cysts.

Factors to take into consideration are:       

 History of voice usage is important: Vocal   overuse, professional voice users such as   teachers.                                                            Phono traumatic event like shouting,   screaming.                                                         History of tobacco and alcohol use.         Findings at flexible and rigid video laryngo   stroboscopic features.                               Response to medical or proper voice therapy.

In some cases, the only diagnosis can be made by examination of the vocal cords and biopsy under direct examination under general anaesthetics in hospital.

 

Vocal Cord Nodules:

Vocal cord nodules are usually secondary to vocal overuse.

They are common in professional voice users such as teachers, singers, lawyers, judges, and preachers.

They are also common in children with vocal overuse.

Patients usually presents with hoarseness or having problems with their singing voice. 

The best way in observing these lesions are either by rigid or flexible video laryngo stroboscopic evaluation done at our voice clinic.

Video laryngo stroboscopic features of vocal nodules are:

 They are fairly symmetric and present on both   vocal cords.                                                         They have minimal influence on vocal fold   vibration.                                                                   It causes an hourglass configuration.             They usually respond well to voice therapy and   rarely needed to be removed surgically.

Vocal Cord Polyps:

Vocal cord polyps are usually secondary to a phono traumatic event such as vocal misuse, such as screaming, yelling or during throat clearing.

Patients usually presents with hoarseness or having problems with their singing voice. 

The best way in observing these lesions are either by rigid or flexible video laryngo stroboscopic evaluation done at our voice clinic.

Video laryngo stroboscopic features of a vocal cord polyp:

They are usually present on only one vocal cord, there may be secondary lesions present on the other vocal cord. This might have the appearance which looks like bilateral vocal cord nodules.                                                                They have minimal to moderate influence on   vocal fold vibration.                                                 It causes an hourglass configuration with glottic   insufficiency.                                                       They usually respond well to good voice   therapy  alone and surgery is only indicated if   they do not disappear on voice therapy alone   and still causing hoarseness.

Vocal Cord Cysts:

Vocal cord cysts are sac like lesions filled with fluid usually located in the mid vocal fold.

There are usually two types of cyst, mucous retention cysts or keratin cysts. They can be congenital (born with it) or acquired.

Patients usually presents with hoarseness.

They can be either superficial in the vocal cord or deeper in the vocal ligament. The deeper ones affect the voice more than the superficial one and they are also more difficult to treat with poorer voice outcomes.                               

 

Polypoid Corditis (Reinke’s edema) are also saclike lesions on the vocal folds usually associated with smoking and vocal overuse.