A significant part of society experiences a hoarseness problem at some stage in its life. Although hoarseness is a complaint that can be seen in both sexes and in all age groups, it is more common in certain groups such as teachers, singers, lawyers, managers, salesmen and older adults. In addition to having a negative impact on quality of life, it is also important because it leads to productivity and labor loss. Although hoarseness is often caused by benign and self-limiting pathologies, it can sometimes be a sign of more serious and progressive diseases such as cancer. The most common benign vocal cord masses we encounter; Vocal cord nodules (calluses), polyps, cysts, vocal cord edema (Reinke’s edema), contact ulcers, granulomas, vocal cord bleeding and webbing (adhesion formations). Let’s take a look at the most common ones;
Vocal cord nodules (calluses):
It is also called singer’s nodule and usually appears as swelling in the free edges of the vocal cords as a result of trauma due to misuse or abuse. They are the most common benign formations and are almost always seen bilaterally and symmetrically. Prolonged speech at low frequencies and high intensity, and improper use of voice are common causes. In addition, it is more common in those with aggressive personality structure, aggressive children in the 4-10 age group, and boys. Professional groups that use their voices too much such as singers, announcers, teachers, administrators, religious officials, and street vendors are more affected. The main symptom of the disease is hoarseness. It is possible to make the diagnosis by video laryngoscopy during a routine ENT examination, and it is seen as symmetrical white-gray masses located in both vocal cords on examination.
In the treatment, first of all, vocal hygiene, speech therapy to prevent incorrect use of voice, voice rest, and psychotherapy in those with an aggressive personality structure (irritable, irritable) should be considered . If adequate sound improvement cannot be achieved with these precautions, the nodule should be microscopically removed (can be done with or without laser) under general anesthesia. Surgical treatment in children should not be considered first and should be delayed as much as possible. It is important for patients to receive voice therapy in the postoperative period in order to prevent nodule recurrence.
Vocal cord polyps:
It is one of the most common benign masses. It is more common in men. Among the causes of its occurrence are the abuse of the voice, allergies and smoking. They are usually seen unilaterally, but sometimes a second mass called reactive nodule can be encountered in the opposite vocal cord due to the continuous hitting of the polyb during speech. The diagnosis is made by observing a smooth-surfaced, broad-based mass during routine videolaryngoscopic ENT examination. Treatment is microscopic removal of the mass (with or without laser) under general anesthesia. Voice therapy before and after the operation is important to prevent recurrence of the disease.
Vocal cord cysts:
Cysts are in the form of smooth-surfaced masses under the mucosa and within the vocal cords. It is usually seen unilaterally, and sometimes it may be accompanied by a second mass called a reactive nodule in the opposite vocal cord. There are two forms called mucus retention cyst and epidermoid cyst. Mucus retention cyst mostly occurs after upper respiratory tract infections. Compared to the epidermoid cyst form, they are larger but soft nature and less disrupt the voice. The form called epidermoid cyst is mostly formed by excessive use of the voice, it is smaller and harder than the other form, it disrupts the voice more.
It is possible to make the diagnosis with a video laryngoscopy during a routine ENT examination. It is possible to distinguish vocal cord cysts more easily from other masses with an examination called stroboscopic examination, in which wave movements in the vocal cord mucosa can be seen. Treatment is microscopic removal of the mass under general anesthesia. Post-operative voice therapy is beneficial in reducing the recurrence of the disease.
Vocal cord edema (Reinke’s edema):
It is formed by the collection of fluid under the vocal cord mucosa and the appearance of the vocal cords is in the form of a water-filled balloon, which can be unilateral or bilateral. It is more common in 30-40 years old. Smoking, poor vocal hygiene, infections (such as chronic sinusitis), stomach acid reflux reaching the vocal cords can trigger reinke edema. The most common symptom is hoarseness. Especially female patients with Reinke’s Edema complain about their voice sounds like a man’s voice. Dry cough and a feeling of irritation in the throat (globus sensation) are the other symptoms.
The diagnosis is made during routine ENT examination and masses in the form of edema and sometimes redness in the vocal cords, and the formation of large polyps in cases where edema is excessive, are seen.
Treatment: It is important to avoid the triggering factors mentioned above (regulation of voice use-speech therapy, treatment of infections, smoking cessation, treatment of reflux). In case of insufficient recovery after these measures, surgical procedures can be performed under general anesthesia by microscopically aspirating edema fluid from the vocal cords or completely stripping the vocal cord mucosa.
Vocal cord granulomas:
Granulomas are mostly seen in men. Common seen situations: After constant cough, throat clearing request and cleansing movements; mucosal damage due to stomach acid rising to the level of the vocal cord (laryngopharyngeal reflux); patients who received general anesthesia and placed a tube in the throat (intubation tube) for any reason; those with tense, nervous, cancer-feared personality traits; profession groups such as lawyers, teachers and managers who use the voice too much. The most common complaints in patients are hoarseness, sore throat, foreign body sensation in the throat, snagging sensation with swallowing, and reflux complaints. Sometimes there may be pain in the ear in the same side of the mass. In the examination, red-white colored tissues that we call granulation tissue are seen on the back of the vocal cords. In the treatment, first of all, some factors that predispose to the formation of granulomas mentioned above should be eliminated: Like regularion of voice habits-speech therapy, reflux treatment, prevention of stress, prevention of cough-throat clearing maneuvers…
Surgical treatment: If the mass has not regressed despite the measures taken at the beginning and has a more mature image, if it grows too large and causes airway obstruction, or if there is a suspicion of malignant diseases such as cancer, the mass should be removed microscopically (with or without laser) under general anesthesia. Post-operative voice therapy is beneficial in reducing the recurrence of the disease.
