A vocal cord granuloma is an inflammatory lesion of the vocal cords, usually occurring on the posterior 1/3 of the cord.
Initial treatment consists of trying to eliminate the irritating agent. This includes removal of an endotracheal tube if possible, treatment of reflux disease, and sometimes voice therapy. Microsurgical removal, with or without use of a laser, is reserved for those patients who do not respond to conservative treatment.
Vocal cord nodules, also known as singer’s nodules or screamer’s nodules, are tiny calluses that form on both vocal cords simultaneously, usually 1/3 of the way back from the anterior-most aspect of the vocal cords.
Like calluses, nodules will usually resolve by removing the cause. Vocal therapy is indicated to decrease vocal cord friction and irritation. This may consist of self-treatment (see Treatment of Mild Hoarseness), or may benefit from professional speech therapy consultation. Microsurgical removal of the nodules is rarely necessary, but may be considered after failure of maximal attempts at voice therapy.
The right and left recurrent laryngeal nerves control the motion of the vocal cords. Damage to one or both of these nerves leads to vocal cord paralysis. Causes of injury to the nerve include inadvertent damage from neck surgery such as thyroidectomy, carotid endarterectomy or others, complications from having an edotrachela (breathing) tube, trauma to the neck or chest, tumors involving the base of the skull, neck, or chest, and viral infections.
If the cause of the paralysis is not apparent, observation, sometimes with speech therapy, may be recommended for up to a year to allow for spontaneous resolution of the paralysis and compensation from the opposite side. Surgical intervention is appropriate if the paralysis is deemed to be irreversible and the symptoms of hoarseness and/or choking are causing significant problems. This can take the form of injecting the paralyzed vocal cord with temporary or permanent fillers to bulk up the cord (vocal cord injection), or repositioning the vocal cord with an implant (thyroplasty). A tracheotomy may be indicated if there are serious breathing problems.
Vocal cord polyps are benign growths originating from one or both vocal cords. Polyps differ from vocal cord nodules in that they are usually larger and more likely to be unilateral. They are usually filled with a jelly-like material that makes them unlikely to resolve spontaneously.
Conservative treatment of vocal cord polyps may include eliminating irritating factors, such as excess stomach acid, or cigarette smoke. Voice rest or speech therapy may be recommended. However, unlike vocal cord nodules, polyps are unlikely to resolve with conservative treatment and generally require surgical intervention consisting of a laryngoscopy and excision of the polyp using microscopic technique.