Vocal cord polyps: symptoms, causes and treatment options

Vocal cord polyps are benign (non-cancerous) swellings on the edge of one or both vocal folds. The review in Healthcare explains that they are commonly on one side, and can be classified by shape (sessile, which sits flat on the fold, or peduncular, on a stalk), by appearance (gelatinous or translucent, fibrous, or angiomatous and haemorrhagic) and by size.

ENT UK groups polyps with nodules as a build-up of soft tissue on the vocal cords. The MyHealth Devon page on hoarse voice lists vocal cord nodules, polyps, cysts and papillomas as local growths, and states that most of these growths are benign in nature, but that throat cancer needs to be excluded as a potential cause of chronic dysphonia.

The review says patients with polyps can experience significant impairment in phonation and communication, and that voice complaints usually involve dysphonia, increased vocal effort and decreased vocal stamina. ENT UK describes hoarseness as a strained, husky or breathy voice, sometimes with differences in loudness or pitch. NNUH adds that a voice problem may come with pain or discomfort in the throat.

• A hoarse, rough, breathy or husky voice.

• A voice that tires quickly or needs more effort to use.

• Changes in pitch or loudness.

• Throat discomfort when speaking.

The Healthcare review says polyps are caused primarily by a coincidence of non-physiological voice use, termed phonotrauma, often associated with yelling or awkward singing, together with other factors such as upper respiratory tract infections, allergies, gastro-oesophageal reflux and smoking. ENT UK says vocal cord polyps are often related to smoking, and that soft tissue growths can develop when the voice is used too much or too loudly for long periods of time.

Many people who develop polyps are simply heavy voice users, and some are smokers; some have both risk factors. Reducing the strain, stopping smoking and treating reflux are the practical steps that ENT UK and MyHealth Devon point to, because they are modifiable.

ENT UK advises that you should seek advice from your GP if you have prolonged hoarseness for more than four weeks, repeated spells of hoarseness without reason, or a prolonged sore throat or difficulty swallowing for more than two weeks, and says it is particularly important if you smoke or drink more than the recommended amount of alcohol. The NNUH page gives a two-week threshold for a voice problem that has not resolved.

MyHealth Devon lists red flag features that suggest something other than a benign growth and should be reviewed quickly: pain on swallowing or difficulty swallowing, a lump or swelling in the neck, a chronic cough, a persistent sore throat or earache, noisy or difficult breathing and unexplained weight loss or fatigue. The NHS laryngitis page says to call 999 or go to A&E for difficulty breathing.

MyHealth Devon notes that there are no specific tests for dysphonia in general and that it is usually diagnosed from the description of symptoms and the sound of the voice, but that referral to an ENT surgeon is suggested if the GP is concerned. ENT UK says the surgeon will examine the throat by passing a flexible telescope through the nose in the outpatient clinic, with no hospital admission needed.

The review explains that vocal fold polyps require multidimensional voice assessment, including vocal fold imaging, listening assessment by clinicians, acoustic and aerodynamic measurements and the patient's own rating of their voice. In practice, a combined ENT and speech and language therapy voice clinic provides much of this.

ENT UK says that, in most cases of hoarseness, the problem relates to how the voice is used, and a voice therapist (speech and language therapist) can give advice or exercises that might help, with therapy sometimes requiring more than one visit. It says an operation, microlaryngoscopy, may be recommended to remove nodules, polyps and benign tumours that are identified at the outpatient visit. It is usually done under general anaesthetic with a rigid telescope and a microscope, and provides a tissue sample for laboratory analysis.

The meta-analysis in Healthcare compared phonosurgery, voice therapy and combined treatment. It notes that although clinical guidelines recommend treating polyps conservatively first and removing them only if results are unsatisfactory, the efficacy of phonosurgery as a primary treatment has been confirmed by observational studies. The review also says that the choice matters because the risks and costs of surgery can be avoided if voice therapy is the first choice, whereas surgery can lead to faster recovery of vocal function. The choice is a shared decision between you and your ENT team.

Self-care measures from ENT UK that apply while waiting are to rest the voice without whispering, drink plenty of fluids, avoid alcohol and cigarette smoke and use antacids if acid builds up in the throat.

The review reports that recurrence after surgery has been found to be low (11%) in one study, and influenced by age, with younger adults having a significantly higher relapse rate than middle-aged or older adults. Stopping smoking, treating reflux and adopting good voice habits are the ways to lower the chance of the problem returning, and ongoing voice therapy is often part of this.

In the NHS the route is generally GP, then an ENT clinic and voice clinic, with speech and language therapy and, where needed, day surgery. Private ENT and voice services follow the same approach. Whichever route is used, a persistent change in the voice should be examined directly by an ENT specialist rather than managed by advice alone.