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glossary2Key Glossary Terms
Vocal Fold Lesions
Specific to this chapter; refers to vocal nodules, vocal polyps, and vocal cysts

Vocal Abuse
Normal vocal behaviors used in excess, leading to vocal fold injury (e.g., excessive loudness or cough)

Vocal Misuse
Abnormal vocal behaviors that cause stress or injury to the vocal folds (e.g., excess tension while speaking)

Vocal Overuse
Normal voice behavior that takes its toll with time (e.g., singer after many years of performing)

Vocal fold lesions refer to a group of benign, abnormal growths (lesions) within or along the covering of the vocal fold. Vocal fold lesions are one of the most common causes of voice problems.

The most common non-cancerous lesions of the vocal folds include:

  • Vocal fold nodules
  • Vocal fold polyps
  • Vocal fold cysts
Vocal Fold Nodules (also called Singer’s Nodes, Screamer’s Nodes)
  • Vocal fold nodules are typically present on both vocal folds.
  • They usually face each other.
  • They are typically located at the midpoint of the membranous part of the vocal fold.
  • These lesions are thought of as the “calluses of the vocal fold.” Analogous to calluses, these lesions diminish or disappear when the trauma/misuse of the vocal folds is stopped.
  • When analyzed under the microscope, nodules have a thickened surface layer of the vocal fold (thickened epithelium) and a thickened superficial lamina propria.
Two Types of Vocal Fold Nodule

Many laryngologists consider the “age” of the vocal fold nodule when deciding upon treatment.

  1. Soft or young nodules most likely resolve on their own; hence voice therapy, not surgery, is typically indicated.
  2. Hard or old nodules generally require surgical removal.

Association with “Extroverts”

Vocal fold nodules are common among children (more common in boys) and are also seen in young adult females. Individuals with vocal fold nodules usually are extroverts and may have a loud voice, which can often be particularly percussive.

Vocal Fold Polyp

A vocal fold polyp typically occurs only on one side of the vocal fold. Although there may be some similarities between polyps and nodules, they look different when examined under the microscope. Polyps are typically more reddish, due to increased blood vessel supply (vasculature). A vocal fold polyp can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances.

Vocal Fold Cyst

A vocal fold cyst is a firm mass of organized material contained within a membrane (sac). The cyst can be located near the surface of the vocal fold or deeper, near the ligament of the vocal fold. (For more information, see Anatomy & Physiology of Voice Production.)

As with vocal fold polyps and nodules, the size and location of vocal fold cysts affect the degree of disruption of vocal fold vibration and subsequently the severity of hoarseness or vother oice problem.

Surgery is the most commonly recommended treatment for vocal fold cysts that significantly alter and/or limit voice. Voice therapy following surgery is typically recommended to maximize vocal recovery after surgery and prevent a recurrent lesion. (For more information, see Phonomicrosurgery.)

Reactive Vocal Fold Lesion

A reactive vocal fold lesion is a mass located opposite another vocal fold lesion, such as a vocal fold cyst or polyp. The reactive vocal fold lesion is thought to be a callus or reaction from trauma or repeated injury from the lesion on the opposite vocal fold. There are two distinguishing features of a reactive vocal fold lesion versus other vocal fold lesions.

  1. There will be minimal to no disruption of the vocal fold vibratory behavior on the side with a reactive vocal fold lesion.
  2. When a reactive vocal fold lesion is treated by voice rest and therapy, it typically will get smaller or completely disappear, while a vocal fold cyst or polyp will not.

What are the causes of benign vocal fold lesions?

The exact cause or causes of benign vocal fold lesions is not known. Lesions are thought to arise following “heavy” or traumatic use of the voice, including voice misuse such as speaking in an improper pitch, speaking excessively, or screaming or yelling.

The formation of vocal fold lesions can also be related to voice use during throat infection such as the common cold. For example, singers who “sing sick” may subsequently develop a benign lesion of the vocal fold. The increased sensitivity of the lining and structure of the vocal folds during the illness may result in the formation of a benign vocal fold lesion. (For more information, see Laryngitis.)

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