Vocal Fold Polyp: Causes, Symptoms & Treatment

Vocal folds are two horizontal tissue folds covered with mucosa, located inside the larynx and responsible for voice production. Benign neoplasms often occur in the area of these vocal folds. These can be, among other things, consequences of incorrect speech or surgical interventions with intubation, through which it can come to the thickening of the vocal folds up to the formation of polyps (vocal fold polyp).

What is a vocal fold polyp?

Schematic diagram showing the anatomy of the vocal cords and their various diseases. Click to enlarge. A vocal fold polyp, or vocal cord polyp, is a benign change that occurs exclusively on the free edge of the vocal fold or on the subglottic slope of the anterior third of the vocal fold. While smaller polyps are broad-based, larger forms are spherical and pedunculated. Vocal fold polyps occur 90 percent of the time on only one side. A distinction is made between edematous (swelling due to fluid accumulation), myxomatous (consisting of unformed mucous and connective tissue base substance) or teleangiectatic (dilated small, superficial skin vessels) pseudotumors. The surfaces of vocal cord polyps are glassy, smooth, spherical and reddish in color. Malignant changes of these polyps are not known.

Causes

The causes of vocal fold polyps, which often occur in middle-aged men, are unclear. It is possible that there is a connection with vocal overload. Since the polyps occur more frequently in cigarette smokers, smoking is also a possible cause. Chronic inflammation and noxious agents that promote inflammation, such as heat, smoke, dust, corrosive vapors, etc., may also be causative factors for vocal fold polyps.

Symptoms, complaints and signs

A vocal fold polyp is manifested by hoarseness, a scratchy throat and other voice disorders. There is also coughing, difficulty breathing, and a foreign body sensation in the throat. Hoarseness is the most obvious symptom and usually persists permanently. Depending on how large the polyp is and where it is located, there may be changes in voice color or even complete voice loss. The voice of the affected person often sounds rough and double-tone, and the voice color can vary greatly in the course of the disease. This can be accompanied by fibrous inflammations near the vocal folds. These repeatedly cause respiratory distress and choking attacks, and in the worst case, the patient may die. If treatment is delayed or omitted, the typical throat problems become so severe that the quality of life is massively reduced. Inflammation can lead to bacterial superinfection. The pathogens can then spread to the surrounding body regions and, in the worst case, cause sepsis. Blood poisoning manifests itself, among other things, by fever and an increasing feeling of illness. Provided that the patient is treated quickly, the symptoms can be alleviated in a targeted manner. One to two weeks after removal of the vocal fold polyp, patients are usually symptom-free again.

Diagnosis and course

A vocal fold polyp can cause more or less pronounced hoarseness or double-tone of the voice sound (diplophonia). As the vocal fold polyp moves back and forth in the glottis during phonation and breathing, there is a recurrent change in the intensity of hoarseness. Patients may experience a foreign body sensation and also suffer from an irritating cough or a constant need to clear the throat. In the case of larger polyps or vocal folds that are additionally swollen due to inflammation, choking can even occur. To detect tissue changes on the vocal folds, a laryngoscopy is performed. In this procedure, the doctor uses a small mirror inserted through the mouth into the throat to view the patient’s vocal cords and larynx. Nasal endoscopy is another helpful examination method. The nasal endoscope is a flexible thin tube. This is passed through the nasal opening down into the throat. Thanks to a light source and a mini-camera at the tip of the endoscope, the doctor can view the vocal folds. Small forceps can also be inserted through the endoscope, for example to take tissue samples.

Complications

Vocal fold polyps that are treated in a timely manner are usually not associated with serious complications.In the event of an unusual course or delayed treatment, the typical symptoms, such as hoarseness, increased pitch of the voice, and coughing and scratching in the throat or other throat problems, can intensify to such an extent that the voice may be temporarily very severely impaired or even lost. Complications can also arise if the polyps need to be surgically removed. Although the removal of a vocal fold polyp is only a minor and usually harmless procedure, certain risks cannot be completely ruled out. For example, heavy bleeding may occur during or after the procedure. Minor injuries to the mucous membranes can also cause the patient to suffer from difficulty swallowing for some time after the operation. Very many patients show hoarseness after surgical removal of a vocal fold polyp, which in severe cases can last for several weeks. Inflammation of the surgical wound, on the other hand, is rare but still possible. This may require treatment with antibiotics, which is often accompanied by unpleasant side effects. Even after successful removal of the polyp, speech therapy may be required to fully restore the voice.

When should you see a doctor?

A vocal fold polyp usually always requires medical treatment. Since this condition cannot heal on its own and usually continues to worsen if left untreated, a medical professional should always be contacted at the first signs and symptoms of the condition. The doctor should be consulted if the patient suffers from severe hoarseness. This may also cause difficulty in breathing, so that patients often feel tired and fatigued. It is also usually difficult for those affected to perform strenuous activities. It is not uncommon for severe shortness of breath to be an indication of a vocal fold polyp and must also be examined by a physician. Most sufferers also continue to exhibit fever and, if left untreated, blood poisoning can lead to the death of the sufferer. In the case of a vocal fold polyp, a general practitioner or an ENT specialist can be consulted. The treatment itself is then performed by a specialist and usually leads to success without complications.

Treatment and therapy

In most cases, vocal fold polyps are removed by means of a small operation, which is performed with the help of an endoscope. This is advanced through the mouth to the larynx, similar to nasal endoscopy. At the tip of this endoscope are all the instruments necessary for the operation. Using small forceps or a laser, the polyp is removed from the mucosa under microscopic vision. This operation is also possible under local anesthesia with special phonosurgeons. The material removed during the procedure should always be histologically examined by a specialist to confirm the diagnosis and rule out a malignant tumor. Following microsurgical removal of vocal cord polyps and after elimination of unfavorable concomitant conditions, speech therapy for voice is necessary in most cases.

Prevention

Since the basic causes for the development of vocal cord polyps are not yet clear, it is hardly possible to prevent this disease directly. But if some elementary things are observed, the risk of it can be reduced. When acute hoarseness occurs, it is better to refrain as far as possible from talking and from anything that irritates the throat even more. This includes not only nicotine and alcohol, but also spicy foods. Clearing the throat should be avoided, as this causes the vocal folds to beat violently against each other, which can lead to inflammation of the vocal folds in the long term. People who have to use their voice a lot (singers, teachers or even journalists) are particularly at risk of hoarseness and should pay special attention to the proper use of their voice.

Aftercare

After the surgical removal of the vocal fold polyp, the aftercare should make sure that the patient rests his voice for about three to ten days. This allows the surgical wound to heal more easily and the tissue defect to regenerate better. If the patient still has to speak from time to time, he should refrain from whispering. Whispering causes greater strain on the vocal cords. Therefore, it is considered more sensible to speak in a normal tone. If postoperative bleeding occurs, it is important to contact the doctor.In addition, the patient must not eat any spicy or hot meals for about a week after the surgical procedure. Likewise, during the healing of the surgical wound, the patient must completely refrain from consuming tobacco products and alcohol. Alcohol in particular increases the risk of postoperative bleeding. Once the period of vocal rest is over, it is recommended to perform a voice therapy exercise. It is considered advisable especially after longer formed vocal fold polyps, because in the course of time it comes to the consolidation of vocal pressure patterns. The length of time that the voice exercise treatments need to take place depends on how the patient individually responds to the various exercises. In most cases, therapy takes about four to six weeks.

What you can do yourself

In everyday life, the consumption of nicotine should be avoided as a matter of principle. This has a negative impact on the health of the affected person in various areas. Therefore, it is advisable to stop smoking in time, both actively and passively. Smoking does not only include the consumption of cigarettes and cigars. Pipe, shisha or e-cigarette should also not be smoked. Since the smoke of the products can basically be inhaled through the air, do not go to places where people smoke. Otherwise, the harmful substances could also enter the organism via so-called passive smoking. In addition, environments where dust or corrosive vapors can be found in the air should be avoided. In everyday life, care should be taken to ensure a good and healthy supply of oxygen. Rooms should be ventilated regularly and outdoor activities are recommended. During leisure activities, attention should also be paid to the places visited and the conditions there. As soon as complaints of the vocal environment are perceived, speaking should be avoided if possible. Communication should be kept to a minimum. Protection of the neck by wearing garments such as a scarf or a loop are advised. Particularly when there is a change of season or in cold environments, the affected person should adequately protect himself with these accessories.