Vocal Cord Polyps
Treatment of benign growths on the vocal cords that can cause hoarseness or voice changes
What is vocal cord polyps?
The vocal cords are two folds stretched across the airway inside the voice box. Air from the lungs sets their upper layer into a wave that produces sound, and the quality of that sound depends on the folds meeting cleanly along their length and on the covering layer staying soft and pliable.
Anything that stops them meeting, or stiffens the covering, changes the voice. That includes swellings caused by repeated forceful use, a fluid-filled cyst, a single fleshy growth, inflammation from acid coming up from the stomach or from smoking, and weakness in one cord where the nerve supplying it has been injured, often during surgery in the neck or chest.
The cords are also where the commonest cancer of the voice box begins. It presents early, as a change in the voice, which is unusual and useful. This is the whole reason for the rule about three weeks: a voice that has not returned to normal in that time is examined, regardless of how well the person otherwise feels.
What you might notice
- A voice that has stayed hoarse
- A voice that gives out after a short time of talking
- A throat infection that keeps coming back
How it is diagnosed
The cords have to be seen. That is done with a small mirror, or more usually with an endoscope passed through the nose or over the tongue, which is quick and done awake in the clinic.
Stroboscopy adds the part that ordinary viewing cannot give. A flashing light synchronised to the pitch of the voice makes the vibration of the covering layer appear to move slowly, so the doctor can see whether the wave travels normally across each cord. A stiff segment shows up here when the cords look almost normal at rest, and it changes both the diagnosis and what is advised.
A speech and language therapist assesses how the voice is being produced and records objective measures. The neck is examined for lumps, and where the picture raises concern, or a cord is not moving, imaging of the neck and chest follows to trace the nerve along its course.
Recovery
Behaviour is the mainstay of treatment for most of these problems and it is slow. Voice therapy runs over weeks to months, retraining how breath and effort are used, and it works better than any procedure for swellings caused by the way the voice is used. Stopping smoking, treating reflux, drinking enough water and avoiding whispering, which strains the cords more than speaking softly, all form part of it.
After surgery on the cord, complete voice rest is usually asked for, commonly a week, and complete means no whispering and no throat clearing. What follows is a graded return guided by the therapist, and pushing that stage is the commonest way a good result is spoiled.
The voice does not sound final for around three months while the covering layer remodels. Professional voice users are advised not to book anything demanding within that window.
If it is left untreated
Some causes settle on their own. Inflammation from a viral illness recovers with rest, and small swellings from a period of heavy voice use often resolve once the pattern of use changes, so watching those for a few weeks is sensible.
What cannot be left is a change that persists. Beyond three weeks the possibility of an early cancer of the voice box has to be excluded by looking, and that is a diagnosis where the difference between early and late treatment is the difference between preserving the voice and losing the voice box.
Long-standing problems also entrench themselves. When one cord is not working, the other overcompensates and the whole mechanism becomes strained, and swellings left in place harden and become fibrous, at which point they respond far less well to therapy. Weakness of both cords is different again and can narrow the airway itself, which needs urgent assessment if breathing becomes noisy or difficult.
Questions about vocal cord polyps
When does a hoarse voice need to be looked at?
Any change in the voice that has not returned to normal within three weeks should be examined, even if you feel entirely well otherwise. Most such changes turn out to be benign, but this is the one presentation where an early cancer of the voice box makes itself known, and the difference between finding it early and finding it late is substantial. Examination is quick and done awake in the clinic with a thin endoscope, and it is not a reason to wait.
Will I need surgery or will therapy be enough?
For swellings caused by the way the voice is used, therapy alone resolves a large proportion and is the first thing tried, usually over two to three months with a speech and language therapist. Surgery is considered when a lesion is structural, such as a cyst or a single fleshy polyp, or when therapy has run its course without change, or when tissue needs sending for examination. Even where surgery is done, therapy continues afterwards, because the pattern of voice use that produced the problem has not changed by itself.
How long is my voice out of action after surgery?
Complete voice rest is usually asked for in the first week, and complete means no whispering and no throat clearing, both of which strain the cords more than gentle speech. After that a therapist guides a graded return over several weeks. The voice continues to change for about three months while the covering layer of the cord remodels, so it should not be judged before then. Singers and other professional voice users are advised not to book demanding work within that window.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about vocal cord polyps
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one