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Understanding the Disorder | Symptoms | Diagnosis | Treatment | Frontiers
 Key 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)
How is the diagnosis of a benign vocal fold lesion made?
A history of how the voice problem started and an evaluation of speaking method are important steps in the diagnosis of benign vocal fold lesions.
Stroboscopy With Rigid Laryngoscope Is Key to Diagnosis
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 laryngoscope with a stroboscopic light source. (For more information, see Laryngoscopy/Stroboscopy.)
- Rigid laryngoscopy provides an optimal, magnified view of the vocal fold surface, allowing the detection of most surface lesions.
- Stroboscopy allows the examiner to assess the mucosal wave as a marker for vocal fold vibration. Assessment of mucosal wave alterations gives insight into the effects of the benign vocal fold lesion on vocal fold vibration.
- Sometimes, a trial of voice rest and/or voice therapy may be instituted, after which changes on the vocal fold lesion are assessed. Vocal nodules tend to resolve partially or almost completely with voice therapy and/or voice rest, while vocal fold cysts and polyps do not.
Investigation for Other Associated Abnormalities
The diagnostic process should also focus on looking for important associated factors, such as:
- Reflux
- Allergies
- Side effects of medications (e.g., diuretics and antihistamines)
- Hormonal imbalance(s)
Accurate Diagnosis Key to Correct Treatment Strategy
The subtle variations among vocal nodules, polyps, and cysts make accurate diagnosis a challenge – especially when swelling is also present.
- Because most otolaryngologists treat vocal fold nodules with voice therapy and rest, but treat vocal fold cysts or polyps with surgery, the importance of making an accurate diagnosis cannot be overemphasized.
- For example, if a patient is given an incorrect diagnosis of vocal fold nodules but actually has a vocal fold cyst on one vocal fold and a reactive lesion on the other, voice therapy will be suggested, the patient will most likely not see adequate improvement in the voice, and surgery will be delayed.
Phonomicrosurgery Advances Provide Benefit, Even to Singers
There is a widely held but erroneous belief in the singing community that a singer should never have surgery on the vocal fold because singing will not be possible after surgery. This is incorrect as a global statement. Phonomicrosurgery for benign vocal fold lesions is highly successful, such that a very high percentage of patients resume all their prior vocal activities, including singing.
Vocal Fold Scar May Co-exist With Vocal Fold Lesions – A Much Bigger Challenge
Often vocal fold scar tissue is associated with vocal fold lesions but will not be noticed during the initial examination. The failure to observe vocal fold scarring is often due to one of two factors.
- Prominence of the vocal fold lesion(s)
- Difficulty in fully assessing the nature and severity of the vocal fold scar due to poor vocal fold vibration and function resulting from the vocal fold lesion(s)
Often the full extent of the vocal fold scarring associated with benign vocal fold lesions cannot be completely appreciated until the vocal folds are examined during microlaryngoscopy at the time of surgery.
- The finding of vocal fold scarring is important given that scarring may affect both choice of treatment and the success of surgery for vocal fold lesions.
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Advisory Note