The term vocal cord lesion or vocal fold lesion refers to a group of noncancerous (benign), abnormal growths (lesions) within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems. The Eugen Grabscheid, MD Voice Center at The Mount Sinai Health System provides comprehensive treatment and services for all types of vocal cord lesions at all stages.

Our Minimally Invasive Laryngology Program uses special laser technology to treat laryngeal and pharyngeal lesions without requiring general anesthesia. Through this approach, your recovery time is much shorter, allowing you to return to your daily routine and quality of life sooner than through traditional surgery.

The Grabscheid Voice Center offers comprehensive speech rehabilitation services as well as facilities equipped with a vocalization room with a piano, so patients can attend therapy sessions throughout their continuum of care.

Types of vocal cord lesions

Types of vocal cord lesions include:

• Vocal cord nodules (singer's nodes, screamer's nodes). Vocal cord nodules are also known as calluses of the vocal fold. They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is halted.
• Vocal cord polyp. A vocal cord polyp typically occurs only on one side of the vocal cord and 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 cord cyst. A vocal cord cyst is a firm mass of tissue contained within a membrane (sac). The cyst can be located near the surface of the vocal cord or deeper, near the ligament of the vocal cord. As with vocal cord polyps and nodules, the size and location of vocal cord cysts affect the degree of disruption of vocal cord vibration and subsequently the severity of hoarseness or other voice problem. Surgery followed by voice therapy is the most commonly recommended treatment for vocal cord cysts that significantly alter and/or limit voice.
• Reactive vocal cord lesion. A reactive vocal cord lesion is a mass located opposite an existing vocal cord lesion, such as a vocal cord cyst or polyp. This type of lesion is thought to develop from trauma or repeated injury caused by the lesion on the opposite vocal cord. A reactive vocal cord lesion will usually decrease or disappear with voice rest and therapy.

Symptoms of vocal cord lesions

A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion. Other symptoms include:

• Vocal fatigue
• Unreliable voice
• Delayed voice initiation
• Low, gravelly voice
• Low pitch
• Voice breaks in first passages of sentences
• Airy or breathy voice
• Inability to sing in a high, soft voice
• Increased effort to speak or sing
• Hoarse and rough voice quality
• Frequent throat clearing
• Extra force needed for voice
• Voice "hard to find"

When a vocal cord lesion is present, symptoms may increase or decrease in degree, but will persist and will not go away on their own.

Detection and diagnosis

The exact cause of benign vocal cord lesions is unknown. 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, screaming or yelling, or using the voice excessively while sick.

Diagnosis begins with a complete history of your voice problem and an evaluation of your speaking method. Your doctor will carefully examine your vocal cords, typically using rigid laryngoscopy with a stroboscopic light source. In this procedure, a telescope-tube is passed through your mouth to allow your doctor to see your voice box. Images are often recorded on video. The stroboscopic light source allows your doctor to assess vocal fold vibration.

Sometimes a second exam will follow after a period of voice rest to allow your doctor an opportunity to assess changes in the lesion. Other associated medical problems can contribute to voice problems, such as: reflux, allergies, medication side effects, and hormonal imbalances. Evaluation of these conditions is important to diagnosis.

Treatment of benign vocal cord lesions

The most common treatments for vocal cord lesions are:

• Voice therapy
• Singing voice therapy
• Voice rest
• Phonomicrosurgery, a type of surgery involving the use of microsurgical techniques and instruments to treat abnormalities on the vocal cord

Treatment options vary according to the degree of your voice limitation and your vocal needs. For example, if you are a professional singer with benign vocal cord lesions, voice therapy will improve your speaking voice but not your singing voice. You may need surgery to restore your singing voice.

We Can Help

Physicians at The Mount Sinai Hospital have extensive experience treating diseases of the larynx, including larynx cancer. U.S. News & World Report ranks Mount Sinai among the best in the nation for Ear, Nose and Throat/Head and Neck Surgery. Call us at 212-241-9425 to schedule an appointment. We are conveniently located on the Upper East Side of New York City.