• Vocal Cord Nodules
  
• Laryngitis
  
• Polyps
  
• Cysts
  
• Vocal Cord Granulomas
  
• Pre-malignant and Malignant Lesions of the Larynx
  
• Papillomas
  
• Acid Reflux and the Voice
  
• Aging of the Larynx
  
• Vocal Cord Paralysis and Surgical Options
  
• Spasmodic Dysphonia and Botox
  
• Oromandibular Dystonia and Botox
  
• Vocal Cord Telengiectasias and Hemorrhage
  
  

Vocal Cord Nodules are swellings or "calluses" in the front portion of the vocal cords caused by poor voice habits.  Nodules usually resolve with proper voice use that can be obtained with speech therapy.  Rarely, nodules can persist and require surgical removal.

Laryngitis is swelling and inflammation of the larynx (or "voice box").  Acute episodes of laryngitis are usually from viruses, bacteria or recent voice abuse (yelling or screaming).  Chronic laryngitis is a long-term inflammatory process causing persistent hoarseness.  It is most commonly caused by smoking, chronic sinusitis and stomach acid reflux.  Treatment depends upon the underlying problem.

Vocal Cord Polyps are benign overgrowths of the outer lining of vocal cords.  Polyps are more common in people who smoke, abuse their voice or have stomach acid reflux but they often appear in people with no risk factors.  Treatment usually requires surgical removal, but often speech therapy is also needed to help prevent recurrences.

Vocal Cord Polyp

Vocal Cord Cysts are benign, fluid-filled sac-like lesions of the vocal cord that are attached to the undersurface of the vocal cord mucosal lining.  These are usually treated with surgical excision with or without speech therapy.

Vocal Cord Cyst	Vocal Cord after removal of cyst

Vocal Cord Granulomas are benign "sores" of the vocal cords caused most often by stomach acid reflux.  These usually resolve with treatment of the reflux but they occasionally require surgical removal.


Pre-malignant and Malignant Lesions of the vocal cords and larynx are most common in people who smoke and drink alcohol.  Treatment depends upon the type, extent and location of the lesion.  However, before any treatment begins, a definite diagnosis must be made by taking a sample (or biopsy) of the lesion and having it examined by a pathologist.  Results of the biopsy are usually available in 5 working days.

Vocal Cord Leukoplakia (Pre-malignant Lesion)

Papillomas of the larynx are usually benign, viral lesions which can cause symptoms ranging from hoarseness to complete airway obstruction.  The most common treatment consists of repeated laser ablations of the lesions, as they tend to recur over variable periods of time.

Acid Reflux, otherwise known as Gastroesophageal Reflux Disorder or GERD, refers to the backward flow of stomach contents into the esophagus or throat.  Exposure of the larynx and throat to stomach acid and digestive enzymes can result in injury and irritation of those areas.  Few people actually experience the heartburn or indigestion symptoms commonly associated with reflux.  Hoarseness, cough, frequent throat clearing, throat pain and feeling of a lump in the throat are all common symptoms attributed to reflux.  Treatment includes dietary modification, weight reduction and possibly medication to reduce stomach acid formation.

Aging of the Larynx is usually characterized by decreased vocal clarity, increased breathiness, decreased loudness and slowly changing vocal pitch.  The most common cause for this is vocal cord atrophy.  As we age, our bodies lose muscle tone.  This also occurs to the vocal cord muscles.  When this happens, the shape of the vocal cords become bowed and thus leave a gap when coming together to produce sound.  The result is increased air escaping through the gap leading to increased breathiness and decreased loudness.  In addition, changes in the mucous membrane and bulk of the vocal cords cause changes in pitch.  Speech therapy can often times overcome weakening and deficits caused by aging.  If speech pathology fails, surgical procedures including vocal cord injections or implants can sometimes be of great benefit.  See Vocal Cord Injections and Implants for more information on surgical alternatives.

Spasmodic Dysphonia is a neurological movement disorder of the larynx which falls under the general category of disorders called dystonias.  There are two types of spasmodic dysphonia: adductor and abductor.  Adductor is more common but many patients may have a combination of the two types.  Adductor spasmodic dysphonia involves involuntary closure of the vocal cords during speech and causes abrupt start-stops and breaks in speech.  Abductor spasmodic dysphonia involves involuntary opening of the vocal cords and results in abrupt, intermittent breathy, whispery-like voice.  Both types are treated with Botox (botulinum toxin) injections into the muscles responsible for the spasms.  These injections are performed in the office, under local anesthesia and need to be repeated every 3-6 months depending upon the severity of the symptoms and response to the botox.  In very severe cases not responsive to Botox, surgical selective resection of the nerves involved in the spasms may be of benefit.  See Dystonia Medical Research Foundation (DMRF) website for further information. 

Oromandibular Dystonia is a neurological movement disorder affecting the muscles which open and close the jaw.  It can cause difficulty with speaking, chewing and swallowing because of lack of control of the jaw muscles and sometimes the tongue.  Like spasmodic dysphonia, the cause of this disease is unknown and likely involves many factors. These disorders may be divided into jaw opening and jaw closing dystonias depending upon which group of muscles is more affected. In some cases it may be a combination of both groups of muscles that are affected.  The disorder is diagnosed and treated by a team of neurologists and otolaryngologists.  Treatment is with a combination of medications and Botox (botulinum toxin) injections. See Dystonia Medical Research Foundation (DMRF) website for further information. 

Botox is a medication derived from botulinum toxin, the poison responsible for botulism.  Botox works by preventing nerves from communicating with the muscles they serve.

Vocal Cord Telengiectasias are enlarged blood vessels in the mucous membrane of the vocal cord.  These blood vessels can form hemorrhagic polyps (as is seen in the right vocal cord) or they can bleed (hemorrhage) underneath the mucous membrane (as is seen in the left vocal cord).  Treatment is laser ablation of the enlarged blood vessel(s).

Submucosal hemorrhage

Hemorhragic polyp