Vocal Fold (Vocal Cord) Lesions

The most common type of laryngeal cancer is Squamous Cell Carcinoma.  Risk factors for this type of cancer include smoking and drinking. Patients with laryngeal cancer may present with symptoms of hoarseness, pain, and even difficulty breathing. First the diagnosis of a cancer must be confirmed with a biopsy, then the cancer is staged, and recommendations are made for treatment.

A vocal fold cyst is a membrane-bound sac which can be filled with mucus and is found underneath the surface of the vocal fold.  A cyst can be very superficial or deeper into the vocal fold.  Cysts often do not respond completely to voice therapy and can be removed with [phonomicrosurgery].  

Laryngeal granulomas are benign and located on the posterior aspect (back end) of the vocal folds. They can be on one side or both sides of the larynx.  Granulomas can cause severe throat pain and irritation of the throat, and even pain in the ear. They are associated with a history of intubation trauma, trauma from voice abuse or chronic cough, and acid reflux. Treatment of granulomas depends on the cause, size, and symptoms. Granulomas will very frequently come back if they are simply removed.

Laryngitis is defined as inflammation of the larynx, and it can cause a hoarse voice.  Laryngitis can be can be acute (lasting less than 3 weeks) or chronic (lasting longer than 3 weeks).  It can be caused by infections (viral, bacterial, or fungal) or noninfectious causes of inflammation (acid reflux, allergies, trauma, voice overuse or misuse, coughing, burn, or medications).  The treatment of laryngitis depends on the underlying cause.

The term leukoplakia literally means "white patch."  A white patch on the larynx can be caused by infection, inflammation, pre-cancerous lesions, and early cancers.  These lesions are treated in different ways depending on the underlying cause.

Vocal fold nodules are referred to as "calluses" on the vocal folds.  They are found on the mid-portion of the true vocal folds bilaterally.  Nodules, also known as nodes or singer’s nodules, are usually the result of voice overuse, misuse, abuse, or excessive coughing.  The initial treatment of vocal fold nodules is with [voice therapy] with or without voice rest.

Papillomas are benign, warty lesions caused by certain strains of the Human Papilloma Virus (HPV). They can occur anywhere in the mouth, nose, and throat. When they occur on the vocal folds they can cause hoarseness and even difficulty breathing. While the lesions are commonly removed surgically with many possible techniques, they frequently recur.

Varices or ectasias of the vocal folds are enlarged blood vessels on the surface of the vocal folds.  They may cause problems if they rupture causing a [vocal fold hemorrhage], or if they affect the ability of the vocal folds to vibrate normally.

A vocal fold hemorrhage is blood that has leaked out of an injured blood vessel and into the true vocal fold.  It is essentially a bruise within the vocal fold.  It can be caused by vocal abuse and misuse especially in the setting of a varix (enlarged blood vessel) on the surface of the vocal fold or by trauma to the neck.  It is treated initially with voice rest and possible voice therapy.  The underlying cause should also be treated to prevent recurrence.

Scarring of the vocal folds, often due to injury or trauma, causes thick and stiff tissue to replace the normal soft and pliable tissue of the vocal folds, which can disrupt the vibrations of the vocal folds.  This disrupted vibration can cause hoarseness and difficulty maintaining a consistent voice.