What are Vocal Fold Cysts, Nodules, and Polyps?
Vocal fold cysts, nodules, and polyps are three different kinds of lesions that can affect a persons voice. Many people - including many doctors - confuse the terms when they are really very different entities.
Speech happens with a combination of vibration of the vocal folds against one another, amplification of the sound through the throat, mouth, and nasal passages (which actually forms the voice), and articulation of vowels and consonants by the tongue, soft palate, and lips. When something keeps the vocal folds from closing completely, the extra air creates a hoarseness or breathy-ness to a person's voice. This can be caused by cysts, nodules, polyps or scarred tissue.
Cysts, nodules, and polyps are non-cancerous.
Symptoms, Causes and Treatment of Nodules, Polyps, and Cysts
Vocal fold nodules are also known as Singer's Nodes or Screamer's Nodes. They occur in pairs that sit directly across from one another "at the midpoint of the membranous part of the vocal fold. These lesions are thought of as the 'calluses of the vocal fold'. Analogous to calluses, these lesions diminish or disappear when the trauma/misuse of the vocal folds is stopped" (www.voiceproblem.org). As the alternative names suggest, this condition is common among people who have a tendency to overuse their voice - coaches, people that yell or scream, singers, actors/actresses. It is also common in those who drink caffeinated beverages, which actually dehydrate the vocal folds, and don't drink sufficient rehydrating fluids during the day.
Nodules are common in children, more in boys than in girls, and also in young adult females.
If the nodules are soft they are more likely to resolve on their own with voice therapy. Hard nodules - usually those that have been present for a long time - will likely need to be removed with surgery.
Vocal fold polyps tend to happen on only one side of the vocal fold, and are redder in color than nodules, since there is increased blood supply. The amount of disruption to the voice depends on the extent and size of the polyp. (This is the condition for which Julie Andrews underwent surgery and lost much of her vocal range when a portion of her vocal flap was inadvertently removed with the polyp.)
The most common causes of polyps are chronic inflammation of the vocal cords from allergies, chronic sinusitis, cigarette smoke, and/or chronic reflux.
Vocal fold cysts is a build up of material within a membrane. These cysts can appear on the surface of the vocal fold or near the ligament. If a cyst is having a profound effect on the voice, then surgical removal will be warranted.
Neither vocal fold polyps or cysts respond to vocal therapy or rest.
Symptoms of any one of these lesions can include:
- vocal fatigue
- unreliable voice
- delayed voice initiation (sound doesn't come out right away)
- low, gravelly voice
- low pitch
- voice breaks in first passages of sentences
- airy or breathy voice
- inability to sing in high, soft voice
- "hiss" sound
- increased effort to speak or sing
- horse and rough voice quality
- frequent throat clearing
- extra force needed to create louder sound
If these symptoms persist without other respiratory illness involvement, or after upper respiratory conditions finish, then a stroboscopy will be done to visually examine the vocal folds.
It is important for a doctor, otolaryngologist, or otorhinolaryngologist to know the difference between these three entities so that effective treatment can be initiated. Since polyps and cysts don't respond to vocal therapy, surgery is often the recommended treatment. Sometime nodules are misdiagnoses as cysts and surgery recommended, when really only vocal therapy is necessary. In many cases, treatment will likely not be initiated unless the condition seriously affects a person's ability to speak or sing.
Sources: http://emedicine.mescape.com; www.doctorhoffman.com; www.voiceproblem.org; http://voicedoctor.net; www.wellsphere.com; www.blues101.org; www.wikipedia.com