Vocal Cord Polyps and Nodules

Phonotrauma (overuse of the vocal cords) leads to mechanical stress and occasionally results in callouses (nodules) or larger growths (polyps). The difference between a polyp and nodule is sometimes arbitrary. A large nodule is a small polyp, and vice versa. In this photo, some might characterize the left vocal fold lesion (left side of the photo) as a large nodule, while the right sided vocal fold lesion might be considered a small polyp.

Both types of growth result from vocal overuse. In general, nodules have a change of decreasing in size and even disappearing if the phonotraumatic behavior is eliminated. Whereas polyps rarely disappear without surgery. In this case, I doubt either of these vocal fold lesions would regress with voice rest or voice therapy. Hence surgery was recommended.

Functional Dysphonia

An often puzzling form of hoarseness is "functional" dysponia. Functional refers to the fact that anatomically and physiologically, the larynx is working properly. But through some environmental, psychologic, or subconscious mechanism the brain has retrained the individual to speech in an abnormal way. The voice can range from being absent, very high pitched, or strained.

Functional dysphonia tends to occur after a respiratory infection, when acute laryngitis may lead to vocal fold swelling and inflammation. This may trigger the patient to change the way that they speak, and when the laryngitis resolves, they may get stuck in this particular pattern.

Stress or trauma can trigger episodes, as a form of conversion disorder. This may occur with or without physical trauma. Occasionally, a strangling injury will lead the patient to "guard" their voice by misusing the neck muscles.

As opposed to common neurologic causes of hoarseness like vocal cord paralysis and spasmodic dysphonia, functional dysphonia has the ability to come and go.

Additional contributing factors include vocal fold inflammation from acid reflux, sinus inflammation, cough, or vocal abuse.

Our office has moved!

We are excited to announce the relocation of our practice effective January 26, 2012! Our new office is located at 180 Newport Center Drive, Suite 158, Newport Beach, CA. For appointments, please call (949)266-1630.

Mariano Rivera - Vocal Cord Problems

http://tracking.si.com/2011/11/23/mariano-rivera-may-need-require-vocal-cord-scraping/


I am sharing this blog post from SI.com regarding Yankee star Mariano Rivera. While it sounds sexy, the term "scraping" is extremely inaccurate to describe the delicate process of surgery on the vocal folds. Phonomicrosurgery, the term we use to describe highly magnified and precise surgery of the vocal folds, is inaccurately described by this sports blogger. But we will have to excuse the blogger, because after all he is a sports writer rather than a medical one.

Singer Adele’s vocal cord surgery in Boston called a ‘success’

Singer Adele’s vocal cord surgery in Boston called a ‘success’

My fellowship mentor, Steven Zeitels, has been in the news this week after operating on the British singer Adele. She reportedly suffered a vocal hemorrhage from a benign vocal fold polyp.

Right Vocal Cord Paralysis

Granular Cell Tumor of the Larynx

Left Vocal Fold Granular Cell Tumor

Pictured is a left vocal fold granular cell tumor.  When this patient presented, the left vocal fold lesion was suspected to be either a mucoid cyst or polyp.  But during surgery it became obvious that the lesion was infiltrative and adherent to the underlying lamina propria, unlike a cyst or polyp.  This patient happened to be a professional singer, and underwent successful surgery to remove the lesion while preserving the voice.   The lesion was biopsied and then ablated with very narrow margins using the pulsed KTP laser.