Vocal cord polyps

What is a vocal cord polyp?

A vocal cord polyp is a small, non-cancerous lump that grows on one of your vocal cords, usually as a result of straining your voice. It changes how your vocal cords vibrate and close together, which is what causes a hoarse or rough-sounding voice.

What are the symptoms of a vocal cord polyp?

The main symptom of a vocal cord polyp is hoarseness, which is usually painless. Other symptoms can include:

• a breathy, rough or scratchy-sounding voice
• your voice cracking or cutting out, especially if the polyp has a narrow base and flips in and out of place
• a feeling of a lump in your throat, or wanting to clear your throat
• your voice tiring quickly or getting worse the more you use it
• a reduced vocal range
• neck pain.

Rarely, a large polyp can cause breathing difficulty, though this is unusual.

What are the causes of vocal cord polyps and who is at risk?

Vocal cord polyps are usually caused by repeatedly straining your voice, though they can also form after just one episode of vocal strain, such as shouting at a sports event or a big night out.

This physical stress on the vocal cords is sometimes called phonotrauma, and some experts believe polyps form when small blood vessels in the vocal cord rupture and bleed.

You're at greater risk if your voice is in heavy or frequent use, for example if you're a teacher, singer, coach, lawyer or salesperson, or if you smoke, since tobacco appears to make polyps larger. Other things that can contribute or make polyps worse include:

• acid reflux (GORD)
• sinusitis or allergies
• an underactive thyroid
• drinking excess alcohol or caffeine
• using your voice while you have a cold or chest infection.

Are there different types of vocal cord polyps?

Yes. Polyps can be described by their shape and how they're attached to the vocal cord:

• Sessile polyps: These have a wide base attached directly to the vocal cord.
• Pedunculated polyps: These have a narrow stalk, a bit like the neck of a balloon, and can flip in and out of position as you speak.

They can also be classified by their appearance: gelatinous (soft and translucent), fibrous, or angiomatous (also called hemorrhagic), where small blood vessels inside the polyp have bled.

Polyps are related to, but different from, vocal cord nodules and cysts. Nodules are calluses that form on both vocal cords, usually from long-term voice strain, while cysts are fluid-filled sacs that usually form on just one vocal cord. Polyps usually affect one side too, though friction from a polyp can occasionally cause a second one to form on the opposite vocal cord.

How are vocal cord polyps diagnosed?

A specialist called an ear, nose and throat doctor, will ask about your voice use and medical history, and examine your throat.

The key test is usually a laryngoscopy, where a thin, flexible tube with a camera is passed through your nose to look at your vocal cords, sometimes combined with a stroboscopy, which uses a special flashing light to show your vocal cords vibrating in slow motion. This combination is considered the best way to assess hoarseness and confirm a diagnosis. Occasionally, a small tissue sample (biopsy) is needed if it isn't clear whether a growth is a polyp or something else.

How are vocal cord polyps treated?

Treatment depends on the size of the polyp, how long you've had it, and how much it's affecting your voice.

Non-surgical treatment for vocal cord polyps

Voice rest on its own can ease your symptoms a little, but a polyp is usually too firm to shrink away completely with rest alone. Voice therapy with a speech and language therapist is almost always recommended, both to help you understand what caused the polyp and to support your recovery, whether or not you go on to need surgery.

For small polyps, especially if you've only had symptoms for a short time, voice therapy alone is sometimes enough to improve your voice and shrink or resolve the polyp, avoiding the need for surgery. Treating any underlying contributing conditions, such as acid reflux, allergies or sinusitis, and making changes like stopping smoking, can also help.

Some specialists offer a steroid injection directly into the polyp, which can fully resolve it in around 3 in 5 people, and reduces the polyp enough in some others to avoid surgery altogether.

Surgical treatment for vocal cord polyps

Many polyps, particularly larger ones or those that haven't improved with the treatments above, need to be removed surgically. This is usually done as microsurgery, using tiny instruments passed through your mouth under general anaesthetic, or with a laser, which is especially useful for polyps fed by blood vessels.

Laser treatment can sometimes be done in an outpatient clinic while you're awake, or under general anaesthetic in an operating theatre, and you may need a second session to fully remove the polyp. Voice rest and voice therapy afterwards are important for the best recovery and to reduce your chances of developing another polyp, which is otherwise low.

When should I see a doctor?

See a doctor if you're hoarse, or have other symptoms of a vocal cord problem, for more than two to three weeks. Because smoking-related growths and, rarely, cancerous growths can cause similar symptoms, it's worth getting persistent hoarseness checked rather than assuming it's a polyp.

Seek medical help urgently if a lump in your throat grows quickly over a matter of weeks, or if you develop breathing difficulty, as these are not typical of a straightforward polyp and need prompt assessment.