Diagnostic Considerations

Vocal cord cysts have a fluid-filled or semisolid center surrounded by a capsule. Occurring much less frequently than vocal fold nodules (VFNs) and vocal fold polyps (VFPs), two types exist: mucous retention cysts and epidermoid cysts. Cysts are typically not associated with phonotrauma and are unlikely to resolve with voice therapy alone.

Vocal fold cancer (laryngeal cancer) should also be included in the differential if there are worsening symptoms, known risk factors (ie, tobacco use), or suspicious findings on videostroboscopy.

Vocal fold papillomas are small wartlike growths caused by the human papilloma virus (HPV). Papillomas also present with voice changes but when large can also cause shortness of breath. Treatment of papillomas typically requires surgical removal.

Workup

El Uali Abeida M, Fernandez Liesa R, Valles Varela H, Garcia Campayo J, Rueda Gormedino P, Ortiz Garcia A. Study of the Influence of Psychological Factors in the Etiology of Vocal Nodules in Women. J Voice. 2011 Nov 14. [QxMD MEDLINE Link].
Cipriani NA, Martin DE, Corey JP, Portugal L, Caballero N, Lester R, et al. The Clinicopathologic Spectrum of Benign Mass Lesions of the Vocal Fold due to Vocal Abuse. Int J Surg Pathol. 2011 Oct. 19(5):583-7. [QxMD MEDLINE Link].
Yamasaki R, Behlau M, Brasil Ode O, Yamashita H. MRI anatomical and morphological differences in the vocal tract between dysphonic and normal adult women. J Voice. 2011 Nov. 25(6):743-50. [QxMD MEDLINE Link].
Dikkers FG, Nikkels PG. Benign lesions of the vocal folds: histopathology and phonotrauma. Ann Otol Rhinol Laryngol. 1995 Sep. 104(9 Pt 1):698-703. [QxMD MEDLINE Link].
Nakagawa H, Miyamoto M, Kusuyama T, Mori Y, Fukuda H. Resolution of Vocal Fold Polyps With Conservative Treatment. J Voice. 2011 Nov 12. [QxMD MEDLINE Link].
Vasconcelos D, Gomes AOC, Araujo CMT. Vocal Fold Polyps: Literature Review. Int Arch Otorhinolaryngol. 2019 Jan. 23 (1):116-24. [QxMD MEDLINE Link]. [Full Text].
Cho KJ, Nam IC, Hwang YS, Shim MR, Park JO, Cho JH, et al. Analysis of factors influencing voice quality and therapeutic approaches in vocal polyp patients. Eur Arch Otorhinolaryngol. 2011 Sep. 268(9):1321-7. [QxMD MEDLINE Link].
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. 1999 Mar. 13(1):128-42. [QxMD MEDLINE Link].
Gray SD, Titze I, Lusk RP. Electron microscopy of hyperphonated canine vocal cords. J Voice. 1987. 1(1):109-115.
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. 2000 Jun. 14(2):240-6. [QxMD MEDLINE Link].
Shah RK, Woodnorth GH, Glynn A, et al. Pediatric vocal nodules: correlation with perceptual voice analysis. Int J Pediatr Otorhinolaryngol. 2005 Jul. 69(7):903-9. [QxMD MEDLINE Link].
Roy N, Holt KI, Redmond S, et al. Behavioral characteristics of children with vocal fold nodules. J Voice. 2007 Mar. 21(2):157-68. [QxMD MEDLINE Link].
Kuhn J, Toohill RJ, Ulualp SO, et al. Pharyngeal acid reflux events in patients with vocal cord nodules. Laryngoscope. 1998 Aug. 108(8 Pt 1):1146-9. [QxMD MEDLINE Link].
Czerwonka L, Jiang JJ, Tao C. Vocal nodules and edema may be due to vibration-induced rises in capillary pressure. Laryngoscope. 2008 Apr. 118(4):748-52. [QxMD MEDLINE Link].
Lechien JR, Saussez S, Nacci A, et al. Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review. Laryngoscope. 2019 Mar 20. [QxMD MEDLINE Link].
Gomaa MA, Hammad MS, Mamdoh H, Osman N, Eissawy MG. Value of high resolution ultrasonography in assessment of laryngeal lesions. Otolaryngol Pol. 2013 Sep-Oct. 67(5):252-6. [QxMD MEDLINE Link].
Gray SD, Hammond E, Hanson DF. Benign pathologic responses of the larynx. Ann Otol Rhinol Laryngol. 1995 Jan. 104(1):13-8. [QxMD MEDLINE Link].
Effat KG, Milad M. A comparative histopathological study of vocal fold polyps in smokers versus non-smokers. J Laryngol Otol. 2015 May. 129 (5):484-8. [QxMD MEDLINE Link].
Wang CT, Liao LJ, Lai MS, Cheng PW. Comparison of benign lesion regression following vocal fold steroid injection and vocal hygiene education. Laryngoscope. 2013 Jul 30. [QxMD MEDLINE Link].
Wang CT, Lai MS, Cheng PW. Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions. JAMA Otolaryngol Head Neck Surg. 2017 Jun 1. 143 (6):589-94. [QxMD MEDLINE Link].
Dasse R, De Mones Del Pujol E. First-line treatment of exudative vocal fold-lesions by in-office local corticosteroid injection: a literature review. Eur Ann Otorhinolaryngol Head Neck Dis. 2020 Nov 12. [QxMD MEDLINE Link].
Wu CH, Lo WC, Liao LJ, Kao YC, Wang CT. Vocal Fold Steroid Injection for Benign Vocal Lesions in Professional Voice Users. J Voice. 2021 Mar 8. [QxMD MEDLINE Link].
Jensen JB, Rasmussen N. Phonosurgery of vocal fold polyps, cysts and nodules is beneficial. Dan Med J. 2013 Feb. 60(2):A4577. [QxMD MEDLINE Link].
Agarwal J, Wong A, Karle W, Naunheim M, Mori M, Courey M. Comparing short-term outcomes of surgery and voice therapy for patients with vocal fold polyps. Laryngoscope. 2019 May. 129 (5):1067-70. [QxMD MEDLINE Link].
Benninger MS. Microdissection or microspot CO2 laser for limited vocal fold benign lesions: a prospective randomized trial. Laryngoscope. 2000 Feb. 110(2 Pt 2 Suppl 92):1-17. [QxMD MEDLINE Link].
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. 1999 Feb. 108(2):156-64. [QxMD MEDLINE Link].
Mizuta M, Hiwatashi N, Kobayashi T, Kaneko M, Tateya I, Hirano S. Comparison of vocal outcomes after angiolytic laser surgery and microflap surgery for vocal polyps. Auris Nasus Larynx. 2015 Dec. 42 (6):453-7. [QxMD MEDLINE Link].
Ragab SM, Elsheikh MN, Saafan ME, et al. Radiophonosurgery of benign superficial vocal fold lesions. J Laryngol Otol. 2005 Dec. 119(12):961-6. [QxMD MEDLINE Link].
Bastian RW. Vocal fold microsurgery in singers. J Voice. 1996 Dec. 10(4):389-404. [QxMD MEDLINE Link].

Media Gallery

Vocal fold polyp (VFP) found during office videostroboscopy.
This picture shows the surgical view of a vocal fold polyp (VFP) as observed via high-power microlaryngoscopy.
This picture is a postoperative surgical view immediately following microsurgical removal of vocal fold polyp (VFP).
Videostroboscopy of postoperative vocal fold polyp (VFP). This is an image from office examination of the same patient as in Image 3, 6 days following VFP removal. Note the straight edge of the vocal fold (right side of image).
Along the anterior right true vocal fold, a pedunculated hemorrhagic polyp is seen. Surgical treatment is indicated. Video courtesy of Vijay R Ramakrishnan, MD.
In this patient with hoarseness, opposing nodules are clearly seen at the anterior one third of the true vocal cords. These responded nicely to outpatient nonsurgical treatment (voice therapy). Video courtesy of Vijay R Ramakrishnan, MD.

of 6

Author

Candace M Hrelec, MD Staff Otolaryngologist, Section of Laryngology, Head and Neck Institute, The Voice Center, Cleveland Clinic

Candace M Hrelec, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Paul C Bryson, MD Associate Staff, Cleveland Clinic Foundation Voice Center, Head and Neck Institute

Paul C Bryson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Phi Beta Kappa, Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

John Schweinfurth, MD 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 Laryngological Association, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

Robert A Buckmire, MD Associate Professor,Department of Otolaryngology-Head and Neck Surgery, University of North Carolina; Chief, Divison 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, National Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Medscape Reference thanks Vijay R Ramakrishnan, MD, Assistant Professor, Department of Otolaryngology, University of Colorado School of Medicine, for assistance with the video contribution to this article.

Vocal Polyps and Nodules Differential Diagnoses

Diagnostic Considerations

References

Tables

Contributor Information and Disclosures

What would you like to print?