VOCAL CORD POLYP, VOCAL FOLD POLYP
Vocal fold polyp is a piece of meat that can be seen anywhere on vocal cords. It may have a stalk or may be sessile. Vocal cord polyp is more frequently observed on men compared to women. Vocal fold polyp is caused by tobacco smoking, poor, wrong and excessive voice use, violent voice use and frequent throat clearing. In contrast to nodules, which are observed on fixed position on vocal folds, vocal cord polyps can be seen anywhere on vocal folds, unilaterally or bilaterally. Vocal cord polyp is larger in size than nodule. Polyp can be single or multiple. People who excessively tense their neck and throat muscles during speech are especially prone to the development of vocal cord polyps. They are seen in people who speak loudly, yell frequently, scream very often and cry loudly. They are the problems of people who have to speak all day long, such as teachers, sales representatives, call center workers. They are commonly observed on professional voice users, such as singers, actors, actresses and politicians. Tobacco smokers are prone to development of vocal polyps.
Vocal fold polyps cause hoarseness, vocal fatigue, diplophonia and husky voice. The voice is usually scratchy. The patient does not have a clear and smooth voice. The patient may feel throat or neck discomfort or pain after he spoke excessively. When voice fatigues, the patient may not phonate at all. Polyp on vocal cords cause discomfort in throat. The patient feels a tickle in his throat as if there were a foreign body in his throat. He tries to relieve this tickle by throat clearing or coughing. These behaviors cannot remove polyp; in contrary, they cause enlargement of polyp by striking it to tissues around. When left untreated for a long time, vocal fold polyp may enlarge in dimensions and narrow laryngeal lümen to cause shortness of breath.
The diagnosis of vocal fold polyp is done by ear-nose-throat examination and endoscopy of vocal folds through the nose or the oral cavity.
Surgical removal of vocal polyp is the treatment of choice. Hospitalization is not necessary for surgery of vocal polyps. The patient comes to the hospital with an empty stomach. He is taken to the operation room. He is made to sleep under general anesthesia. The surgeon inserts a metal tube (called laryngoscope) through patient’s mouth to his throat. A microscope is placed between the surgeon and laryngoscope to enlarge vocal folds. The surgeon removes vocal polyp through laryngoscope by using various long instruments. No incision is performed on any part of body of the patient. The operation takes around an hour. Two hours after surgery the patient is ready to go home. He is not allowed to drive home; somebody else has to drive him. There is no food or drink restriction after nodule surgery. The patient has to obey a 7-day absolute voice rest postoperatively; speaking or whispering is strictly prohibited. During this voice rest communication is through writing. One day of throat pain is normal after surgery. Some of the patients may experience numbness on tongue and inability to taste foods for several weeks. This happens because nerves of the tongue is squeezed by the laryngoscope and it is always reversible.
Voice therapy after surgery prevents recurrence of vocal polyp. During voice therapy, as the poor voice use habbits are removed and replaced by the correct voice use technique, vocal polyp does not recur in most of the cases. Voice therapy is a behavioral treatment. The correct phonation method is taught to the patient. The patient has to quit the tense phonation technique that he is used to. Relaxation of neck and throat muscles is advised. Correct method of inspiration and expiration is shown and practiced. The patient is required to attain soft phonation technique.
Vocal fold polyps are not cancerous and they do not convert to cancer later. However, some cancers of vocal folds may mimic vocal fold polyp and can mislead the surgeon to false diagnosis of polyp. That is why all vocal cord polyps have to be removed and examined histologically to rule out cancer. It is the best treatment approach to excise vocal polyp without waiting for a long time. The patient must be advised to quit smoking tobacco.
