Disease Description (Causes and Symptoms)
- Definition: A vocal cord (laryngeal) polyp is usually a unilateral submucosal mass (polyp) that develops in the middle of the membranous portion of the vocal cord. Its mechanism involves submucosal hemorrhage and fibrosis caused by excessive voice use and chronic inflammation. It is more common in adults than in children and may rarely be multiple.
- Causes/Pathophysiology: Repeated, forceful phonation (voice abuse/misuse), smoking, and chronic laryngitis (including reflux esophagitis and allergies) → submucosal hemorrhage → nodule formation/polyp development. Epithelial dysplasia may be observed in some polyps, particularly pedunculated polyps, so histological confirmation is necessary.
- Main symptoms: Persistent or intermittent hoarseness (dysphonia), vocal fatigue, diplophonia (double-frequency voice), rough voice quality, breathy voice, and voice breaks or pitch changes at high pitches. Patients generally have difficulty intentionally controlling vocal intensity and pitch.
Treatment Methods
- Nonsurgical (Conservative) Treatment
- Voice therapy (phonation training with a speech-language pathologist and correction of voice abuse): Attempted for early-stage or small polyps. However, it tends to be less effective than for nodules.
- Vocal hygiene: Smoking cessation, frequent water intake, avoiding excessive voice use, and managing sleep and stress.
- Treatment of reflux and hypertrophic conditions: Medication treatment (such as proton pump inhibitors and antihistamines) when acid reflux (reflux esophagitis) or allergies are present.
- Surgical Treatment
- Microlaryngoscopic excision: Removal of the polyp while preserving the vocal cord mucosa and mucosal wave (vibration) as much as possible. Most unilateral polyps are removed on one side.
- Laser treatment: May sometimes be used as an adjunctive treatment for edematous or recurrent lesions.
- Postoperative tissue examination: To rule out epithelial dysplasia or malignant findings.
- Postoperative Management
- Initial voice rest (usually for several days), followed by gradual voice rehabilitation (voice therapy is essential).
- Smoking cessation, continued reflux treatment, and avoidance of excessive phonation.
- Precautions and Risk of Complications
- If untreated, voice disorders may persist or worsen, causing occupational problems (for singers, teachers, etc.).
- Surgical complications: Vocal cord scarring (damage to the mucosal wave → residual voice disorder), bleeding, recurrence, and, rarely, problems related to intubation or anesthesia.
- Prognosis
- With appropriate surgery and rehabilitation, the rate of voice improvement is high. Recurrence is possible without long-term voice management, including avoidance of voice abuse.
Outpatient Visit Checkpoints (Including Preparation and Sample Questions)
- Items/Information to Prepare
- A list of currently used medications, including anticoagulants and antiplatelet agents
- Results of previous laryngeal or voice-related examinations (videos, endoscopic photographs, or records)
- The onset and course of symptoms (when they worsen and in what situations), and occupation (degree of voice use)
- Smoking history (duration and amount), alcohol use, and whether acid reflux symptoms are present (heartburn or acid regurgitation)
- If available, submit a voice sample (recorded on a mobile phone)
- Points to Note on the Day of the Visit
- If your usual voice-use pattern differs, make a note of it, including when the hoarseness is most severe
- If you are taking anticoagulants, inform the doctor before the procedure
- Sample Statements for Information to Submit to the Doctor Before the Visit
- "I would like to show you how my voice has changed over the past few weeks, including a recording."
- "This is how much I usually smoke, and I have reflux symptoms."
General Sample Questions to Ask the Doctor
- How likely is it that this polyp is malignant? Is a biopsy necessary?
- If surgery is recommended, what is the expected recovery period and when is voice recovery expected?
- What are the main risks and complications of the surgery? How high is the risk of scarring (damage to the vocal cord mucosal wave)?
- How likely is improvement with conservative treatment (voice therapy, smoking cessation, etc.)?
- When can I resume normal activities, singing, and teaching after surgery?
Disease-Specific Sample Questions
- "Is my polyp unilateral? Was epithelial dysplasia (or any other abnormal finding) identified on the biopsy?"
- "How long will voice therapy be needed after surgery, and do you recommend a specialized voice therapy program with a speech-language pathologist?"
- Additional (occupation-related): "My job requires prolonged, forceful phonation. What specific practices can help reduce the risk of recurrence?"