Vocal Cord Lesion Treatment

The vocal cords are two bands of muscle tissue found inside the larynx or voice box. A vocal cord lesion refers to any type of benign growth or injury that occurs on the vocal cords. Many of these are the result of vocal overuse or misuse of the cords.

These lesions, which are one of the most common causes of voice disorder, are categorized into three main groups, namely nodules, polyps and cysts.

The vocal cords come together forcefully to meet in the midline while the voice is being used. Thus they may suffer trauma with repeated episodes of overuse or even a single incident of massive voice abuse.

This is manifested in various ways, beginning with swelling. If it is a one-time episode, voice rest for several days is usually sufficient to resolve the swelling.

With repeated abuse, the swelling may become chronic and a vocal cord cyst or polyp may form.

Steps in treating vocal cord lesions

The most common approach to treating vocal cord lesions includes voice rest, voice therapy and phonomicrosurgery. Treatment begins with voice therapy which involves a qualified speech pathologist working on voice placement and air flow with the patient. However, for established vocal cysts or polyps, surgery may be required after voice training.

Since voice abuse is responsible for a variety of vocal cord lesions, complete abstinence from all forms of vocal sound production for 5-7 days, followed by a slow and careful return to normal phonation, may be very useful in restoring normalcy.

A surgeon may employ phonomicrosurgery, a technique that involves the use of visualizing the vocal cords under magnification while the patient is under general anesthesia, and using very slender long instruments to operate on the cords. The aim of this minimally invasive surgery is to remove any lesions, while maximizing the chances of preserving intact the nearby healthy vocal cord tissue.

Since this is required for vocal cord vibration, keeping it undamaged is crucial to achieving positive voice outcomes for the patient. In expert hands, this procedure may offer excellent chances of retaining optimal vocal cord function.  

Other techniques which may be used as indicated include the KTP laser, microdebridement, and vocal fold injections (as in medialization laryngoplasty).

The importance of the lamina propria

In previous years, surgeons had not come to fully appreciate the importance of preserving the gelatinous layer of the connective tissue, also referred to as the lamina propria. They believed that removing the swelling from the vocal cord and achieving an even vocal edge was the chief measure resulting in the restoration of normal vocal function.

A procedure called vocal cord stripping was used, in which the surgeon would strip the epithelial covering from the cord if the swelling was extensive. It has now been realized that this caused severe damage to this gelatinous layer, impairing normal healing by resulting in adherence of the injured epithelial covering to the underlying fibrous tissue.

This could lead to permanent hoarseness of the voice, which was often even worse than before the patient underwent surgery. Thus today, surgeons try to ensure this layer of the lamina propria is preserved. The surgery usually takes about one hour and is usually followed by a week of voice rest.

The patient then attends voice therapy sessions and the period and intensity of use of the voice is gradually increased. However, it is important that the underlying cause of the vocal disorder is addressed, as otherwise lesions may return.

Any other medical problems that may contribute to the voice disruption such as sinusitis, allergy or acid reflux, will also require treatment. Patients may also be offered advice about giving up smoking and reducing alcohol intake or their stress levels.

References

• http://www.uofmhealth.org/conditions-treatments/vocal-fold-lesions-nodules-cysts-and-polyps
• https://my.clevelandclinic.org/services/head-neck/diseases-conditions/hic-vocal-cord-lesions
• http://www.entnet.org/content/nodules-polyps-and-cysts
• http://www.northshore.org/otolaryngology-head-neck-surgery/adult-programs/voice-center/conditions/nodules-polyps--cysts/
• http://www.britishvoiceassociation.org.uk/voice-information_vocal-nodules.htm
• http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/otolaryngology/phonotrauma_benign_vocal_fold_lesions_22,phonotrauma/