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Vocal Polyp

Fluid-filled collections that form on the edge of a vocal cord.

What is a vocal fold polyp?

Polyps are fluid-filled collections that form on the edge of a vocal cord. They are a result of vocal trauma without periods of rest.

 

 

What does that mean?

Vocal folds (also called vocal cords or, by some, vocal chords) are not just strings in your voice box. They’re actually folds of tissue with a delicate lining on the outside.

When seen from above, the vocal folds look like a “V”

The vocal folds vibrate (or contact each other) several hundred times per second when singing and speaking. This puts a lot of stress on the vocal folds. Speaking or singing incorrectly, in a bad environment (i.e., smoky, dry, etc), or for prolonged periods of time causes them to swell.

Once your vocal cords are swollen, one of two things can happen. Either:

  1. The vocal cords return to normal if you rest your voice OR
  2. The vocal cords stay swollen if you continue to use your voice

If you continue to use your voice and the cords stay swollen, that swollen material becomes thicker and thicker until it becomes too thick to go away on its own. It is then called a polyp.

Analogy: It is similar to what happens if you burn your hand on something hot. First, you get a watery blister. If you open up that blister, it has water in it. However, if you keep using your hand where the blister is, the water goes away and the material in the blister becomes thicker. It is no longer watery inside. The same thing happens inside the vocal folds.

What is vocal trauma?

Vocal trauma is using your voice:

  • Too much
  • Too loud
  • Incorrectly
  • In a bad environment (i.e., noisy bar, smoky club, large room)

Vocal trauma causes the vocal fold lining to swell, which may lead to nodule formation if you do not rest.

What is rest?

Resting may mean not speaking at all. It may also mean:

    • Learning to speak correctly
    • Not speaking in bad environments
    • Using amplification
What are the symptoms?

Symptoms of polyps vary based on your vocal demands.

If you are a vocational voice user (i.e., someone who uses their voice for their living, such as a singer, actor, voiceover artist, etc), you will possibly notice:

  • Hearing two pitches at the same time
  • Hearing a flutter in your voice
  • Hoarseness in your speaking voice
  • Hoarseness (irregular, inconsistent quality) in your professional voice (singing, voiceover, etc)
  • Decreased range (no longer hitting higher notes easily)
  • Inability to sing quietly
  • Inability to hold a pitch steady
  • Decreased color or vibrancy of tone
  • Vocal fatigue (feeling worn out after a performance)
  • Throat discomfort, pain, or tightness
  • Neck pain

Self-Check:

Try to sing “Happy birthday” as quietly as you can. Are you able to hit all notes easily and quietly?

If not, you may have nodules or another vocal problem.

If you are an avocational voice user (i.e., not someone whose voice is their livelihood, such as a doctor, teacher, lawyer, etc), you will possibly notice:

  • Vocal fatigue (feeling worn out after a performance)
  • Throat discomfort, pain, or tightness
  • Neck pain
  • Hoarseness in your speaking voice
What does a polyp look like?
A polyp is a growth that comes off the surface of the vocal fold. It can be filled with clear fluid (and look more transparent) or blood (and appear reddish). The polyps that are filled with blood are called “hemorrhagic polyps.”  
How do I know if I have a polyp?

The only way to know if your symptoms are due to a polyp is to have your vocal cords examined. This requires the use of videostroboscopy by a laryngologist.

A general ENT usually cannot see if you have a polyp with the traditional scope. That is because the equipment available to most general ENTs is not sophisticated enough to get a close view of the vocal folds and their vibration.

Complications of a polyp

Are there possible complications of polyps?

There are complications to nodules, particularly when the diagnosis is made too late. Complications include:

  • Permanent hoarseness
  • Scarring
  • Painful phonation/voice use
  • Loss of vocal range

How can I avoid having a complication?

Early diagnosis is the key to avoiding these complications. This means, for a singer, coming in for evaluation as soon as you are hoarse.

Singers incorrectly assume it is okay to be hoarse after a long performance or rehearsal. It is not normal to be hoarse at these times; hoarseness is an indication that something is wrong. Evaluation at this time is critical to ensure reversibility.

Unfortunately, people often ignore hoarseness because when they rest, it goes away. However, that is exactly the time to come in. Hoarseness that is goes away usually means your vocal problem is reversible. When you find that your hoarseness never goes away, that may means it is too late and you have an irreversible vocal problem that may need surgery.

Truths & Myths

I hear conflicting things about polpys. What is the truth?

Myth: A polyp mean the end of my career

Truth: While polyps often require surgery, if caught early, there is less damage to the vocal folds. That means a more successful surgery.

Myth: Polyps require surgery.

Truth: Polyps do not always require surgery. Some singers are able to sing as they need to with a polyp.

Myth: Polyps are not preventable

Truth: Polyps often occur to due voice overuse or misuse. If good vocal hygiene is used, you may be able to prevent a polyp.

Myth: I can just stay silent for one month and the polyp will go away for good.

Truth: While total voice rest will make your voice improve, as soon as the voice is used again, it will worsen.

Myth: Polyps are just bad luck. I can’t prevent them

Truth: You can definitely lower your risk of getting a polyp. Sing with perfect technique, don’t smoke, rest your voice, and your chances go down significantly.

What is the treatment?

Treatment is most effective when a polyp is caught early and diagnosed correctly.This may seem simple, but without videostroboscopy it is nearly impossible.

Can I just see my regular doctor?

Unfortunately, few people are trained to correctly diagnose and treat voice disorders. Most doctors will simply push steroid pills on singers. While this often does make the situation better, it is not a long term solution. As soon you try difficult vocal tasks again, the problem will recur. Each time you are hoarse, you are potentially creating irreversible damage that a regular physician cannot see.

Only a laryngologist can accurately diagnose and treat you, and help prevent you from having a worse problem.

What should I ask my doctor when I see him/her to ensure I’m getting the right treatment?

It is very difficult for a patient to differentiate a qualified voice physician from someone who calls himself a voice doctor simply because their wall is covered in artists’ head shots. Most singers rely on word of mouth, which may not lead to a true laryngologist.

You should ask your voice physician the following questions to ensure you are getting the treatment you deserve:

      1. Are you board certified in ENT?
      2. Are you fellowship-trained in laryngology/professional voice?
      3. Do you perform videostroboscopy?
      4. Do you perform the examination on your patients?*
      5. When surgery is needed, do you perform the surgery yourself or are there other doctors or doctors-in-training involved?*
      6. Do you accept insurance? Are your services covered by insurance?

*Often, laryngologists are located in facilities where residents or fellows (doctors-in-training) perform a large portion of the services.

How do you handle vocal fold polyps?

At the Division of Voice and Laryngology of the Osborne Head and Neck Institute (OHNI), we understand that your voice is your livelihood. We take the utmost care to prevent poor voice outcomes. Your evaluation at OHNI includes:

  • A complete history
  • A complete physical exam of the head and neck
  • Laryngoscopy
  • Videostroboscopy
  • Treatment planning – this usually includes voice therapy with a skilled therapist, trained in the treatment of voice disorders

With appropriate treatment, we are able to help your polyp resolve completely, often without surgery.

Does insurance pay for a laryngologist visit?

If the laryngologist accepts insurance, your visit is usually covered. Laryngoscopy with stroboscopy is also usually covered. It is best to ask your doctor’s office billers to clarify insurance issues.

Contact

Contact Dr. Reena Gupta

If you would like to speak with Dr. Gupta or another one of our physicians regarding an ear, nose, throat problem; or have other questions or concerns, please complete the contact form below or call us at 310-657-0123.