Nodules, Polyps and Cysts Can Affect Voice and Lifestyle

Every voice is unique, defining personality, mood and health, but the voice is often taken for granted unless a problem occurs. In the United States, there are about 7.5 million people who have trouble using their voices. Three types of vocal cord growths - nodules, polyps and cysts - are often the cause.

"Vocal cord nodules, polyps and cysts generally have little relationship to pre-cancers or cancers," says Joel H. Blumin, MD, Medical College of Wisconsin Associate Professor of Otolaryngology and Communication Sciences. "But they do cause hoarseness and are among the most common reasons that patients come to see an otolaryngologist. These problems are highly treatable and intervention leads to improvement in most cases."

Nodules are most often bilateral (on both vocal cords) and in general involve just the outer layer of tissue. "I tell patients they're like a callus. The outer layer of skin on the vocal cord thickens," explains Dr. Blumin.

"Polyps are a distension of the surface of the vocal cord," he notes. They are softer than a nodule and are more like a blister than a callus.

"Cysts are like water balloons under the surface of the vocal cord. They're usually filled with a mucous-like fluid. Both polyps and cysts tend to be unilateral (on one vocal cord)."

Causes
"When people use their voice inefficiently, it creates uneven pressures or alters the way they use their vocal cords," says Dr. Blumin. "Sometimes people talk with a raspy or tight voice, which can strain or damage the vocal cords. Excessive yelling and screaming can also cause injury, resulting in polyps and cysts or allowing a nodule to develop."

Dr. Blumin explains that these conditions can also occur when allergies or infections cause inflammation in the vocal cords. "The tissue swells up and people have to push harder to talk. If they're pushing too hard, a nodule can develop. The nodule doesn't vibrate well and the person has to push even harder, creating a vicious cycle of irritation," he says.

Gastroesophageal reflux also causes problems for many of Dr. Blumin's patients. "Reflux occurs when gas and acids come backwards from the esophagus into the throat, which can lead to irritation of the larynx," Dr. Blumin says.

Assessment
An examination by an otolaryngologist (an ear, nose and throat specialist) is the first step in diagnosing a voice problem. Any change in voice quality - for instance, if the voice sounds tight, raspy, gravelly or rough - might signal a disorder.

Most people with nodules, polyps and cysts see their doctors initially for hoarseness. "The hoarseness can range from something that is disabling, in which the patient would be unable to communicate, to something more subtle," says Dr. Blumin.

Among people who rely on their voices professionally, such as singers or speakers, even slight voice changes can affect the way they are perceived.

As part of an initial assessment, the doctor will ask about the patient's medical history, listen to the quality of the voice and inspect the vocal cords. "I do an indirect laryngoscopy (viewing the back of the throat with a small telescope) as part of my standard evaluation on the first office visit," Dr. Blumin says.

"Most patients who come in with voice problems actually get a videostroboscopic examination, which uses a telescope connected to a flickering light source and a computer. These tools allow us to make precise evaluations of the fine movements of the vocal folds," he adds.

Healthy Voice
Vocal cord disorders usually don't go away on their own, but most of them - especially nodules - can be healed with therapy, medication, or lifestyle changes rather than surgery.

To help prevent voice problems:

• Drink plenty of water - moisture is good for the voice.
• Try not to scream or yell; use a microphone when speaking outside or making a presentation to large groups.
• Warm up your voice before heavy use.
• Don't smoke.
• Listen to your voice. If you become hoarse, modify your voice to allow the vocal cords to recover. Pushing your voice when it's already hoarse can lead to significant problems.
• If your voice is hoarse frequently, or for an extended period of time, you should be evaluated by an otolaryngologist.

"The prognosis is great for these patients," says Dr. Blumin. "Hoarseness and voice problems affect people's lives, socially and professionally. If you're hoarse, you don't have to just deal with it. We have a world-class otolaryngology department here at the Medical College and there are things that we can do to help. With treatment, most of these conditions will get better in a matter of months."

Susan Hunnicutt
Healthlink Contributing Writer

Eileen Early, BA, BSN, RN
HealthLink Editor

Joel H. Blumin, MD, is a Medical College of Wisconsin Associate Professor of Otolaryngology and Communication Sciences and Chief of the Division of Laryngology & Professional Voice.

This article contains information from the National Institute on Deafness and Other Communication Disorders.

"Your Health" provides easy-to-understand information about common health conditions.