eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Vocal Polyps and Nodules: Follow-up

Author: Robert A Buckmire, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina; Chief, Division of Voice and Swallowing Disorders, Director, University of North Carolina Voice Center
Contributor Information and Disclosures

Updated: Sep 8, 2008

Outcome and Prognosis

With respect to vocal fold nodules (VFNs) and vocal fold polyps (VFPs), treatment often results in vocal improvement. With respect to vocal fold nodules (VFNs), Murray et al demonstrated a beneficial effect of voice therapy when compared with observation alone. No prospective randomized studies compare the natural history of VFPs to the outcomes of standardized treatment regimens. However, relatively convincing evidence within the literature supports the safety and efficacy of these techniques in improving perceptual, aerodynamic, and stroboscopic parameters (based on the growing aggregate of reported surgical series of patients managed operatively with conservative phonomicrosurgery).

In 1996, Bastian reported his personal surgical series of 62 singers who had undergone microsurgery (the second-largest series reported in this patient population at the time).13 Even within this high-risk population, evidence supported the safety and efficacy of surgical therapy. However, note that perhaps the most striking element of the study was the meticulous patient selection process, as well as preoperative and postoperative therapeutic and behavioral regimens. Reportedly, all singers within the series were able to return to a level of public singing at least equal to that experienced preoperatively.

Given the presumed pathophysiology, the long-term prognosis for patients with vocal fold nodules (VFNs) and vocal fold polyps (VFPs) appears dependent on maintenance of hygienic vocal behaviors. Patients unable or unwilling to participate in this fashion are arguably poor candidates for surgical intervention.

Future and Controversies

Undoubtedly, the debate over ideal surgical techniques, instrumentation, and therapeutic regimens will continue as more data become available. Further research of bioimplantable materials will ideally render the potentially disastrous vocal complications of phonosurgery, such as scarring and loss of vibratory capacity, easier to treat.

 


More on Vocal Polyps and Nodules

Overview: Vocal Polyps and Nodules
Workup: Vocal Polyps and Nodules
Treatment: Vocal Polyps and Nodules
Follow-up: Vocal Polyps and Nodules
Multimedia: Vocal Polyps and Nodules
References
[ CLOSE WINDOW ]

References

  1. Dikkers FG, Nikkels PG. Benign lesions of the vocal folds: histopathology and phonotrauma. Ann Otol Rhinol Laryngol. Sep 1995;104(9 Pt 1):698-703. [Medline].

  2. Hogikyan ND, Appel S, Guinn LW, et al. Vocal fold nodules in adult singers: regional opinions about etiologic factors, career impact, and treatment. A survey of otolaryngologists, speech pathologists, and teachers of singing. J Voice. Mar 1999;13(1):128-42. [Medline].

  3. Gray SD, Titze I, Lusk RP. Electron microscopy of hyperphonated canine vocal cords. J Voice. 1987;1(1):109-115.

  4. Andrade DF, Heuer R, Hockstein NE, et al. The frequency of hard glottal attacks in patients with muscle tension dysphonia, unilateral benign masses and bilateral benign masses. J Voice. Jun 2000;14(2):240-6. [Medline].

  5. Shah RK, Woodnorth GH, Glynn A, et al. Pediatric vocal nodules: correlation with perceptual voice analysis. Int J Pediatr Otorhinolaryngol. Jul 2005;69(7):903-9. [Medline].

  6. Roy N, Holt KI, Redmond S, et al. Behavioral characteristics of children with vocal fold nodules. J Voice. Mar 2007;21(2):157-68. [Medline].

  7. Kuhn J, Toohill RJ, Ulualp SO, et al. Pharyngeal acid reflux events in patients with vocal cord nodules. Laryngoscope. Aug 1998;108(8 Pt 1):1146-9. [Medline].

  8. Czerwonka L, Jiang JJ, Tao C. Vocal nodules and edema may be due to vibration-induced rises in capillary pressure. Laryngoscope. Apr 2008;118(4):748-52. [Medline].

  9. Gray SD, Hammond E, Hanson DF. Benign pathologic responses of the larynx. Ann Otol Rhinol Laryngol. Jan 1995;104(1):13-8. [Medline].

  10. Benninger MS. Microdissection or microspot CO2 laser for limited vocal fold benign lesions: a prospective randomized trial. Laryngoscope. Feb 2000;110(2 Pt 2 Suppl 92):1-17. [Medline].

  11. Remacle M, Lawson G, Watelet JB. Carbon dioxide laser microsurgery of benign vocal fold lesions: indications, techniques, and results in 251 patients. Ann Otol Rhinol Laryngol. Feb 1999;108(2):156-64. [Medline].

  12. Ragab SM, Elsheikh MN, Saafan ME, et al. Radiophonosurgery of benign superficial vocal fold lesions. J Laryngol Otol. Dec 2005;119(12):961-6. [Medline].

  13. Bastian RW. Vocal fold microsurgery in singers. J Voice. Dec 1996;10(4):389-404. [Medline].

  14. Courey MS, Gardner GM, Stone RE, et al. Endoscopic vocal fold microflap: a three-year experience. Ann Otol Rhinol Laryngol. Apr 1995;104(4 Pt 1):267-73. [Medline].

  15. Courey MS, Shohet JA, Scott MA, et al. Immunohistochemical characterization of benign laryngeal lesions. Ann Otol Rhinol Laryngol. Jul 1996;105(7):525-31. [Medline].

  16. Dikkers FG, Nikkels PG. Lamina propria of the mucosa of benign lesions of the vocal folds. Laryngoscope. Oct 1999;109(10):1684-9. [Medline].

  17. Hochman II, Zeitels SM. Phonomicrosurgical management of vocal fold polyps: the subepithelial microflap resection technique. J Voice. Mar 2000;14(1):112-8. [Medline].

  18. Kleinsasser O. Pathogenesis of vocal cord polyps. Ann Otol Rhinol Laryngol. Jul-Aug 1982;91(4 Pt 1):378-81. [Medline].

  19. Kotby MN, Nassar AM, Seif EI, et al. Ultrastructural features of vocal fold nodules and polyps. Acta Otolaryngol. May-Jun 1988;105(5-6):477-82. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

vocal nodules, vocal polyps, vocal polyp, vocal fold polyps, vocal fold nodules, hemorrhagic polyps, vocal fold lesions, VNs, nodules vocal cord, vocal cord polyp, vocal cords, dysphonia, vocal, vocal lesions, vocal training, true vocal folds, phonotrauma

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert A Buckmire, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina; Chief, Division of Voice and Swallowing Disorders, Director, University of North Carolina Voice Center
Robert A Buckmire, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and National Medical Association
Disclosure: Nothing to disclose.

Medical Editor

John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Medical Society of the State of New York
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.