Understanding The Disorder
Vocal Fold Lesions
The term “vocal fold lesion” is a general term for a growth on the vocal folds, and refers to vocal nodules, vocal polyps, and vocal cysts. Vocal fold lesions may be associated with phonotrauma.
Normal vocal behaviors used in excess, leading to vocal fold injury (e.g., excessive loudness or cough)
Abnormal vocal behaviors that cause stress or injury to the vocal folds (e.g., excess tension while speaking)
Normal voice behavior that takes its toll with time (e.g., singer after many years of performing)
Vocal Fold Lesions Disrupt Vocal Fold Closure and Vibration
Regardless of type, benign vocal fold lesions – nodules, polyps, or cysts – cause hoarseness by disrupting the ability of the vocal folds to close together and vibrate.
Is Key to Diagnosis Stroboscopy is a special way of looking at the vocal folds with a rapidly flashing light, which permits evaluation of vocal fold vibration. Stroboscopic examination of the vocal fold lesion(s) is essential for accurate diagnosis and successful treatment. Determining the type of vocal fold lesion(s) is important since some respond well to voice therapy alone while others may require surgical removal.
The most common symptom of a benign vocal fold lesion is a change in voice quality, ranging from mild to severe. The voice can be affected during speaking, singing or both. Often, hoarseness will be associated with an increased effort to talk and subsequent fatigue or tiring of the voice with continued use.
Common Symptoms Associated with Benign Vocal Fold Lesions
- Vocal fatigue
- Unreliable voice
- Low pitched, gravelly voice
- Voice breaks
- Airy or breathy voice
- Inability to sing in a high, soft voice - Hoarse and rough quality
- Extra force needed for loud voice
Symptoms in patients with vocal fold lesions persist. Although symptoms may sometimes increase and decrease depending on accompanying inflammation, they do not go away on their own.
How is the diagnosis of a benign vocal fold lesion made?
1. Patient History a. A history of how the voice problem started and an evaluation of voice and speaking behaviors are important steps in the diagnosis of benign vocal fold lesions.
2. Stroboscopy is Key to Diagnosis a. Careful examination of the vocal folds is essential for making the diagnosis of a benign vocal fold lesion. Examination is typically performed using a rigid or flexible laryngoscope with a stroboscopic light source.
3. Investigation for Other Associated Abnormalities
The diagnostic process should also focus on looking for important associated factors, such as:
- Side effects of medications (e.g., diuretics and antihistamines)
All treatments are aimed at restoring functional voice abilities. Treatment often includes one or more of the following: speaking voice therapy, singing voice therapy, phonomicrosurgery (surgery on the vocal folds), medication, voice rest.
- Treatment should be reserved for patients with functional limitations of their voice (e.g. voice loss, vocal fatigue, change or limitation in singing voice, etc.) who thus have the motivation to improve voice.
- Often, when a patient notes mild hoarseness but no significant functional limitations or abnormalities, he or she only wants to know if the hoarseness is due to a cancer. If the hoarseness is due to a benign vocal fold lesion, then pursuing no treatment at all is a reasonable approach.
The decision on which treatment to use and in which sequence to proceed is highly complex and should be decided jointly by the voice care team (laryngologist, voice-specialized speech-language pathologist) and patient, based on the individual case.
Voice therapy helps the patient improve vocal symptoms through techniques geared at improving the way the body (muscles, lungs etc.) work together to create voice. These techniques include strategies to reduce phonotrauma, with the additional goal to prevent future injuries to the vocal folds.
Surgery Has High Success Rate
Surgery for benign vocal fold lesion(s) can be highly successful when performed with precise phonomicrosurgical techniques and followed by specialized post-operative voice therapy. As with all surgery, risk is balanced by benefit – the relief of functional voice limitations – and can be ameliorated by proper planning for surgery and postsurgical care.