Vocal cord disorders are any anatomical or functional issue that affects the vocal cords. The vocal cords (also called vocal folds) are two bands of smooth muscle tissue found in the larynx (voice box). The vocal cords vibrate, and air passes through the cords from the lungs to produce the sound of your voice.
Some of the more common vocal cord disorders include the following:
| Vocal Cord Disorder | Description |
| Laryngitis | Laryngitis causes a raspy or hoarse voice due to inflammation of the vocal cords. |
| Vocal nodules | Vocal nodules are noncancerous calluses on the vocal cords caused by vocal abuse. Vocal nodules are often a problem for professional singers. They most often grow in pairs (one on each cord). The nodules most often form on parts of the vocal cords that get the most pressure when the cords come together and vibrate. Vocal nodules cause the voice to be hoarse, low and breathy. |
| Vocal polyps | A vocal polyp is a soft, noncancerous growth similar to a blister. They can include blood within the blister that resolves over time to produce a clear blister. Voice polyps cause the voice to be hoarse, low and breathy. |
| Vocal cord paralysis | Paralysis of the vocal cords may happen when one or both vocal cords doesn’t open or close properly. When one vocal cord is paralyzed, the voice can be weak, or food or liquids can slip into the trachea and lungs, whereby people have trouble swallowing and may choke or cough when they eat. Patients with both vocal cords paralyzed may have trouble breathing. Vocal cord paralysis may be caused by the following:Head, neck, or chest injury.Problem during surgery.Stroke.Tumor.Lung or thyroid cancer. Certain neurological disorders, such as multiple sclerosis or Parkinson’s disease.Viral infection.Treatment may include surgery and voice therapy. Sometimes, no treatment is necessary and a person recovers on his or her own. |
What causes vocal cord disorders?
The most common cause of vocal fold disorders is vocal abuse or misuse. The type of vocal cord disorder (see above) may have different causes. This includes excessive use of the voice when singing, talking, coughing or yelling. Smoking and inhaling irritants are also considered vocal abuse.
What are the symptoms of vocal cord disorders?
Symptoms vary, based on the type of vocal cord disorder. They include changes in your normal voice, such as a raspy or hoarse voice, or a hoarse, low and breathy voice. Vocal cord paralysis may also cause trouble swallowing and coughing.
How are vocal cord disorders diagnosed?
Any hoarseness or change in voice that lasts longer than two weeks should be brought to the attention of your health care provider. It is important to see a voice specialist or ENT for a full examination of the vocal folds if symptoms do not resolve within four weeks.
In addition to a complete medical history and physical exam, the health care provider may examine the vocal cords internally with a small scope called a laryngoscope.
How are vocal cord disorders treated?
Vocal cord disorders caused by abuse or misuse are easily preventable. In addition, most disorders of the vocal cords can be reversed. Your health care provider will figure out the best treatment based on:
- How old you are.
- Your overall health and medical history.
- How sick you are.
- How well you can handle specific medicines, procedures, or therapies.
- How long the condition is expected to last.
- Your opinion or preference.
Treatment may include any of the following:
- Resting the voice.
- Stopping the behavior that caused the vocal cord disorder.
- A referral to a speech-language pathologist who specializes in treating voice, speech, language, or swallowing disorders.
- Medicine.
- Surgery to remove growths.
Key points About Vocal Cord Disorders
- Vocal cord disorders can affect your voice or ability to talk.
- Some of the more common vocal cord disorders include laryngitis, vocal nodules, vocal polyps, and vocal cord paralysis.
- Vocal cord disorders are often caused by vocal abuse or misuse.
- Symptoms may include a raspy, hoarse, low, or breathy voice, or trouble swallowing or coughing.
- Any hoarseness or change in voice that lasts longer than 2 weeks should be brought to the attention of your healthcare provider.
- Vocal cord disorders caused by abuse or misuse are easily preventable.
What are vocal cord lesions (nodules, polyps and cysts)?
Vocal cord lesions, also known as vocal fold lesions, can be benign (noncancerous) or malignant (cancerous) growths that can form on your vocal cords. This article focuses on benign vocal cord lesions.
Your vocal cords are two bands of muscle and vibratory tissue inside your larynx (voice box). They come together and vibrate to produce sound when you speak, sing or use your voice in other ways.
Lesions on your vocal cords can change your voice, making it difficult or even painful to talk or sing.
Types of vocal cord lesions
Benign lesions include vocal cord nodules, polyps and cysts.
Vocal cord nodules
Vocal cord nodules, sometimes called singer’s or screamer’s nodes, can form if you’re repeatedly misusing or overusing your voice. These callus-like growths develop in the midpoint of your vocal cords. This part of the vocal cords gets used most often when you’re using your voice. Often, nodules develop on both vocal cords.
Anyone can get them, but they’re most common in children, heavy voice users such as teachers, trainers and coaches, and professional voice users such as singers and speakers.
Vocal cord polyps
Vocal cord polyps, like nodules, can result from repeatedly overusing or misusing your voice. They can also form after a single episode of vocal abuse (like yelling at a sports event). Polyps can vary in size and shape, but they’re usually larger than nodules. They typically form on one vocal cord, but the friction from a single polyp rubbing against the other vocal cord may cause an additional polyp to form.
A specific type of vocal cord polyp, polypoid corditis (Reinke’s edema), is associated almost exclusively with smoking. If you smoke and become hoarse, you should see a provider to evaluate you for this condition, as well as malignant growths.
Anyone can develop vocal cord polyps, but they’re more common after an episode of voice overuse such as yelling or a sudden loss of voice.
Vocal cord cysts
Vocal cord cysts are growths that have a sac around a fluid-filled or semisolid center. There are two types of vocal cord cysts: mucus retention cysts and epidermoid (sebaceous) cysts. Vocal cord cysts are less common than vocal cord nodules and polyps but can cause many of the same symptoms. They’re not necessarily associated with voice overuse.
Symptoms and Causes
What are the symptoms of vocal cord lesions?
The most common symptom of a vocal cord lesion is hoarseness or a raspy voice. Still, symptoms depend on the lesion’s size and how much it interferes with your vocal cords opening, closing and vibrating together.
Symptoms include:
- Hoarseness.
- Breathiness.
- Vocal fatigue.
- Loss of your voice.
- Loss of your vocal range.
- A voice that breaks easily.
- A harsh, raspy or scratchy voice.
- Frequent coughing, throat clearing or general fatigue.
- General neck pain or a shooting pain that travels from ear to ear.
What causes vocal cord lesions?
Nodules and polyps form over long periods of overusing your voice or using your vocal cords incorrectly. Speaking or singing for extended periods, yelling or straining your voice can all cause your vocal cords to become irritated and inflamed, eventually causing lesions. Singing (particularly in professional singers), screaming and frequent talking (for instance, if you’re a teacher, coach or salesperson) can all lead to nodules or polyps.
Other factors can make you susceptible to lesions or worsen them. These include:
- Smoking.
- Sinusitis.
- Allergies.
- Hypothyroidism.
- Chronic acid reflux (GERD).
- Consuming excessive alcohol or caffeine.
- Using your voice when you’re sick with a cold or upper respiratory infection.
Vocal cord cysts can form if a gland in your vocal cord gets blocked or fragments of cell debris get trapped inside vocal cord tissue.
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Diagnosis and Tests
How are vocal cord lesions diagnosed?
A healthcare provider will examine your head and neck and ask how you’ve been using your voice. They may perform tests to examine your vocal cords directly, including:
- Laryngoscopy: Healthcare providers perform this test to examine your voice box. They insert a thin tube through your nose and mouth with special lights and a video camera that allows them to see your voice box.
- Stroboscopy: Healthcare providers perform this test to see how your vocal cords vibrate. They insert a small scope into your nose or throat, above your vocal cords. The scope connects to a special strobe light that flashes when your vocal cords vibrate. This test is the gold standard for evaluating hoarseness. Laryngologists or speech-language pathologists with specialization in voice typically perform and interpret this procedure.
Management and Treatment
How are vocal cord lesions treated?
Therapy can range from conservative behavioral, medical and dietary treatments to more invasive treatments like surgery.
- Voice therapy: A specialist called a speech-language pathologist might work with you during voice therapy sessions. Voice therapy teaches how to use your vocal cords so they can heal. It can also teach you how to prevent lesions or voice injuries in the future. Nodules are typically treated conservatively with voice therapy under the guidance of a speech therapist.
- Behavioral modifications: Behavioral interventions can help you make lifestyle adjustments to help care for your voice. Quitting smoking, reducing stress and improving your diet can complement voice therapy to ease your symptoms and heal vocal cord lesions.
- Treatments for underlying medical problems: Treatments that address underlying issues that cause vocal cord inflammation, such as reflux, allergies and sinusitis, can help heal lesions and lessen symptoms.
- Surgery: You may need surgery for nodules that don’t improve with more conservative treatments, like voice therapy. You’ll likely need surgery if you have a polyp or cyst. Unlike nodules, polyps and cysts don’t typically improve with voice therapy. Still, you may need voice therapy after surgery to reduce your risk of irritating your vocal cords and developing new lesions.
Prevention
How can I prevent a vocal cord lesion?
To reduce your risk of developing a vocal cord lesion, you should avoid:
- Singing or talking excessively if you have an upper respiratory infection
- Talking excessively or speaking loudly without adequately resting your voice
- Drinking alcohol excessively and consuming too much caffeine (which dry out your vocal cords).
- Smoking or being in smoke-filled rooms
You can also put healthy habits into place to care for your vocal cords and reduce your risk of getting sick.
- Drink plenty of water.
- Wash your hands often.
- Get a good night’s sleep.
- Use a microphone if you need to project your voice.
- Warm up your voice before singing or prolonged speaking.
- Rest your voice in anticipation of future speaking obligations.
- Use a humidifier in your home to keep your vocal cords hydrated.
- Use stress reduction techniques, cognitive therapy, or yoga to lessen muscle tension.
Get treatment for conditions associated with vocal cord lesions, like GERD, sinusitis, allergies and hypothyroidism. See a provider who specializes in voice if you’re concerned you may be developing a voice problem. Early interventions can often prevent invasive treatments such as surgery.
Outlook / Prognosis
What can I expect if I have vocal cord lesions?
Your outlook depends on your lesion type and how severely it’s impacting your vocal cords. Untreated nodules, polyps and cysts can cause long-term damage to your vocal cords. Untreated cysts may potentially burst, causing complications.
With treatment, your outlook is excellent. Nodules usually improve within two to six months with voice therapy or vocal rest. Surgery to remove polyps or cysts, alongside voice therapy and vocal rest, can help return your voice to normal.
What happens to untreated vocal cord nodules?
Untreated vocal nodules can cause you to further strain your voice and injure your vocal cords. Often, nodules improve with voice therapy and behavior modifications alone. Most people don’t need surgery. Still, you’ll need to learn ways to care for your vocal cords as they heal. Healthcare providers, like speech-language pathologists, can teach you how to use your voice so your nodes shrink or go away.
Are vocal cord nodules serious?
Vocal nodules are benign, which means they won’t cause damage throughout your body like a malignant (cancerous) growth can. Still, they can feel painful and affect your ability to communicate. If vocal health is an important part of your career and well-being (for example, if you’re a singer, salesperson, teacher, etc.), having vocal nodules can feel very serious.
The good news is that most vocal nodules are treatable without surgery. They’re also usually preventable if you’re taking steps to care for your voice.
Do nodules on vocal cords go away?
Most nodules go away once you stop misusing your voice. Getting treated for underlying conditions that may cause vocal cord irritation can help, too. Working with a speech-language pathologist can help you identify what you’re doing that caused vocal nodules and what may be worsening them. Once you’re informed, you’ll know what behavior to change.
Living With
When should I seek care?
If you’re hoarse or have other symptoms of a vocal cord lesion for more than two to three weeks, see an otolaryngologist (ear, nose and throat doctor). Or visit a subspecialized laryngologist with extra training in caring for voice disorders.
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