Vocal cord nodules and polyps

Vocal cord nodules and polyps: Excerpt from Handbook of Diseases

Nodules on the vocal cord result from hypertrophy of fibrous tissue and form at the point where the cords come together forcibly. Vocal cord polyps are swellings on the true vocal cord caused by edema in the lamina propria of the mucous membrane. Nodules and polyps have good prognoses, unless continued voice abuse causes recurrence, with subsequent scarring and permanent hoarseness.

Causes

Vocal cord nodules and polyps usually result from voice abuse, especially in the presence of infection. Voice abuse results from speaking consistently at the wrong pitch or for a long duration, and using too loud a voice. Many vocal abusers combine all three practices. Consequently, vocal cord nodules and polyps are seen most commonly in teachers, singers, and sports fans, and in energetic children (ages 8 to 12) who continually shout while playing. Polyps are common in adults who smoke, live in dry climates, or have allergies.

Signs and symptoms

Nodules and polyps inhibit the approximation of vocal cords and produce painless hoarseness. The voice may also develop a breathy or husky quality.

Diagnosis

Persistent hoarseness suggests vocal cord nodules and polyps; visualization by indirect laryngoscopy confirms it.

❑ In the patient with vocal cord nodules, laryngoscopy initially shows small red nodes; later, white solid nodes on one or both cords.

❑ In the patient with polyps, laryngoscopy reveals unilateral or, occasionally, bilateral, sessile, or pedunculated polyps of varying size, anywhere on the vocal cords. (See How nodules cause hoarseness.)

Treatment

Conservative management of small vocal cord nodules and polyps includes humidification, speech therapy (voice rest, training to reduce the intensity and duration of voice production), and treatment of any underlying allergies.

When conservative treatment fails to relieve hoarseness, nodules or polyps require removal under direct laryngoscopy. Microlaryngoscopy may be done for small lesions to avoid injuring the vocal cord surface.

If nodules or polyps are bilateral, excision may be performed in two stages: one cord is allowed to heal before the polyps on the other cord are excised. Two-stage excision prevents laryngeal web, which occurs when epithelial tissue is removed from adjacent cord surfaces and these surfaces grow together.

For children, treatment consists of speech therapy. If possible, surgery should be delayed until the child is old enough to benefit from voice training, or until he can understand the need to abstain from voice abuse.

Special considerations

❑ Postoperatively, stress the importance of resting the voice for 10 days to 2 weeks while the vocal cords heal. Provide an alternative means of communication — Magic Slate, pad and pencil, or alphabet board.

❑ Place a sign over the bed to remind visitors that the patient shouldn’t talk. Mark the intercom so other hospital personnel are aware the patient can’t answer.

❑ Minimize the need to speak by trying to anticipate the patient’s needs.

❑ If the patient is a smoker, encourage him to stop smoking entirely or, at the very least, to refrain from smoking during recovery from surgery.

❑ Use a vaporizer to increase humidity and decrease throat irritation.

❑ Make sure the patient receives speech therapy after healing, if necessary, because continued voice abuse causes recurrence of growths.

CLINICAL TIP: Do not allow the patient on voice rest even to whisper. Whispering involves approximating the vocal cords, which will irritate the cords and increase swelling.

Pictures

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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