What Is a Vocal Cord Polyp?

Vocal cord polyps are benign proliferative lesions that occur in the superficial layer of the vocal cord, and are a special type of chronic laryngitis. The main clinical symptom is hoarseness. A clinical diagnosis can be made by laryngoscopy. The main treatment is surgical resection. If after treatment, patients are still exposed to risk factors such as excessive use of voice, improper use of voice, smoking, etc., vocal cord polyps may reappear. To avoid and treat possible pathogenic factors after surgery.

Basic Information

English name: polypofvocalcord
Visiting department: Otorhinolaryngology
Common causes: Excessive use of voice, improper use of voice, upper respiratory tract infection, exposure to irritating pathogenic factors, endocrine disorders, certain systemic diseases, allergies, laryngo-pharyngeal reflux

Common symptoms: Hoarse

Causes of vocal cord polyps

Various causes of chronic laryngitis can cause vocal cord polyps.

1. Excessive or improper use

It is common in professional speakers such as teachers, actors, and singers. Long-term continuous high-speaking, high-pitched or long-time singing can cause vocal polyps.

2. Upper respiratory tract infection

Colds, acute and chronic laryngitis, rhinitis, sinusitis, pharyngitis, lungs, trachea, bronchitis, etc. can all become the cause of vocal cord polyps. If excessive sound is used in the presence of upper respiratory tract inflammation, vocal cord polyps are more likely to occur.

Nasal, sinus, and pharyngeal infections can be caused by inflammation that directly spreads downward, or inflammatory secretions flowing into the throat, causing obstacles in vocal resonance, which can cause improper vocalization and increase laryngeal muscle fatigue, leading to this disease. When the lung, trachea, or bronchus is infected, the cough can cause the inflammatory secretions produced by it to contact the larynx for a long time, and the disease can also be secondary.

3. Exposure to irritating pathogenic factors

Such as high temperature operation, dust operation, chemical industry, etc. can produce a lot of irritating substances, causing vocal cord polyps. Some studies have pointed out that smoking can stimulate the vocal cord mucosa and dilate blood vessels. Plasma penetrates into the lamina propria of the vocal cord through the blood vessel wall (Renker gap), causing polyp-like changes in the vocal cords.

4. Endocrine disorders

Vocal polyp-like degeneration is more common in menopausal women and may be related to estrogen levels. Hypothyroidism or hyperthyroidism is also related to vocal cord polyp-like changes.

5. Certain systemic diseases

Such as heart and kidney disease, diabetes, rheumatism and other disorders of the vasomotor function, long-term congestion of the throat, the disease can be secondary.

6. Allergy

According to the light microscope and electron microscope histology of vocal cord polyps treated with glucocorticoid therapy and vocal cord polyps, some scholars believe that vocal cord polyps are related to allergies.

7.Laryngopharyngeal reflux

Laryngo-pharyngeal reflux disease has received more and more attention in recent years, and research on this disease has continued to intensify. Some researchers believe that chronic inflammation caused by reflux of gastric contents to stimulate the laryngeal mucosa is also one of the causes of vocal polyps.

Clinical manifestations of vocal cord polyps

Multiple groups

Patients with vocal cord polyps are mostly over-voicing patients. Patients often have characteristics such as irritability, irritability, lack of patience, and are prone to bad vocal habits such as overreaction and shouting.

2. The main symptoms

For different degrees of hoarseness. Early stage is lighter, sound is slightly rough or almost normal, mainly due to vocalization, fatigue, frequent use, sometimes good and bad, intermittent hoarseness; often hoarseness when treble, accompanied by delay, tone Changes, etc .; Some patients may not see obvious sound changes in daily conversation, but when singing, they may have more obvious manifestations such as narrowing of the sound range and limited vocalization. The condition continues to develop, exacerbation of hoarseness, which can progress from intermittent to persistent, and may also occur with lower sounds. When speaking loudly, the voice is unstable, which prompts the patient to use excessive force to vocalize, hoping to achieve the purpose of improving the vocalization effect, but excessive forceful vocalization increases the bad stimulation to the throat. Often hoarseness prevents actors from singing or teachers from teaching. Inquiring about the medical history in detail, patients often have excessive sound.

The degree of hoarseness in patients is related to the size and location of vocal cord polyps. Generally, those with large polyps are more hoarse, otherwise they are lighter. When the polyp grows on the free edge of the vocal cord, the hoarseness is obvious. When it grows on the upper surface of the vocal cord, it has little effect on vocalization. The large polyp of Guangji can completely lose its sound. People with polyps hanging in the subglottic cavity are often accompanied by cough. Huge polyps located between the vocal cords on both sides can completely lose sound and even block the respiratory tract, causing breathing difficulties and wheezing.

Vocal cord polyp examination

Laryngoscopy (indirect laryngoscope, direct laryngoscope, fiber laryngoscope, electronic laryngoscope, stroboscopic laryngoscope, etc.): diagnosis can be made through various laryngoscopes combined with clinical symptoms.

Laryngoscopy showed a smooth, soft, translucent new creature at the junction of the front middle 1/3 of the vocal cord edge, white or pink, with a smooth surface, pediceled or broad-based. Sometimes the free edge of one or both vocal cords has a broad-shaped spindle-shaped polypoid change, and there are also polypoid changes with diffuse swelling throughout the vocal cords. Polyps are grayish or reddish, occasionally purplish red, ranging in size from mung beans to soybeans. Vocal cord polyps are more common on one side, and can occur on both sides simultaneously. A few cases are polyps on one side and nodules on the contralateral side.

Pedicled polyps can move up and down with the breathing airflow, sometimes hidden in the subglottic cavity, which is easy to ignore during inspection. Occasionally, those with large polyps can be seen hanging in the subglottic cavity, like purple grapes, and have difficulty sitting in a sitting shape. There are also those who suddenly block the glottis and cause suffocation. The pedicle of this huge polyp is often located at the joint before the vocal cords. Those who are not satisfied with the indirect laryngoscope observation can use direct laryngoscope, fiber laryngoscope, electronic laryngoscope, stroboscopic laryngoscope, etc. Among them, stroboscopic laryngoscope can observe both vocal morphology and vocal cord movement. In addition, various vocal acoustic assessments and aerodynamic assessments can be performed to understand the extent to which the vocal cords and airflow through the glottis are affected by lesions during vocalization. ^[1-2]

Vocal cord polyp diagnosis

Mainly based on clinical symptoms, that is, a long history of hoarseness, combined with laryngoscopy, clinical diagnosis can be made.

Differential diagnosis of vocal cord polyps

1. Summary of vocal cords

The distinction between vocal cord polyps and vocal cord nodules is mainly based on clinical macroscopic morphology. A typical vocal nodule is a symmetrical nodular uplift at the junction of the front middle 1/3 of the bilateral vocal cords, and a small gray-white uplift at the late stage. The surface is smooth and solid, about half a meter in size.

2. Vocal cord cyst

Including retention cysts and epidermoid cysts. The cysts are hemispherical, with a smooth surface, grayish white, yellowish, or reddish, and the cyst wall is generally thin. It can be fluctuated when touched, and can be distinguished by stroboscopic laryngoscopy.

3. Laryngeal papilloma

It is the most common benign tumor of the larynx and is generally considered to be caused by a viral infection. It can be single or multiple. The mass was pale, reddish or dark red, the surface was often mulberry-like or only rough and uneven like villi, and the pedicel often moved up and down with respiratory airflow, which can be identified by pathological examination.

4. Laryngeal tuberculosis

Mostly located in the back of the larynx, it is characterized by pale larynx mucosa, edema, and multiple superficial ulcers, such as worm-like. Congestion and thickening of the vocal cords may also occur on one side. It can be accompanied by systemic symptoms such as low fever and cough. Chest radiographs, tuberculin experiments, and sputum culture can help identify them.

5. Laryngeal cancer (glottic type)

Occurs in older men, usually with a long history of smoking, and hoarseness is progressively worse. Laryngoscopy shows cauliflower-like or nodular masses located in the vocal cords. The surface is not smooth or rough. It can be attached with pseudo-membrane or ulcers. The texture is brittle and easy to appear. Soundtrack fixed. In the later stage, dyspnea, metastatic cervical lymphadenopathy may occur, and systemic symptoms such as cachexia may occur at the end. ^[3]

Vocal cord polyp treatment

Includes proper vocal cord rest, corrects bad vocal habits, medication and surgical treatment. Vocal cord polyps are mainly surgically removed.

General treatment

The vocal cord rest and vocal training are mainly used for the treatment of vocal cord nodules, and also have a certain effect on vocal cord polyps.

In addition, smoking, drinking and spicy and irritating foods should be restricted, avoiding coffee, strong tea, etc., and avoiding exposure to irritating gases, dust and other pathogenic factors.

2. Drug treatment

Local treatment can be given physical therapy and nebulized inhalation treatment. Inhibit gastric acid secretion, reduce chronic inflammation of throat mucosa caused by pharyngeal reflux, can treat and prevent vocal cord polyps.

3. Surgical treatment

Vocal cord polypectomy is currently the main treatment for polyps. There are a variety of surgical methods, depending on the size and location of the polyp. Smaller polyps can be removed under surface anesthesia with fiber laryngoscope or electronic laryngoscope, but with the development of laryngeal microsurgery technology, most patients with vocal cord polyps use general anesthesia under the support of laryngoscope under microscope Laser resection and micro-flap technique of micro instruments. At present, oral laryngeal surgery techniques are becoming more and more mature, and various types of laser, micro-instruments, plasma knives and other resection methods are changing with each passing day. It is extremely rare that particularly large polyps need laryngomy. ^[4-5]

Vocal cord polyp prognosis

If after treatment, patients are still exposed to risk factors such as excessive use of voice, improper use of voice, smoking, etc., vocal cord polyps may reappear. After surgery, we should continue to avoid and treat possible pathogenic factors. If necessary, we must conduct vocal training to change bad vocal habits and prevent vocal cord polyps from recurring.

Vocal cord polyp prevention

The vocal cord rest and vocal training can prevent the disease to a certain extent. At the same time should avoid smoking, drinking, eating spicy food and exposure to other irritating pathogenic factors, but also pay attention to prevent upper respiratory tract infections such as colds, reduce the cause of vocal cord polyps.

references

1. Edited by Li Xuepei. Otorhinolaryngology. Beijing: Peking University Medical Press, 2003: 164-171.

2. Huang Xuanzhao, Wang Jibao, editor of Kong Weijia. Practical Otolaryngology Head and Neck Surgery. Beijing: People's Medical Publishing House, 2007: 434-445.

3. Edited by Tian Yongliang. Otorhinolaryngology Head and Neck Surgery. Beijing: People's Medical Publishing House, 2008: 192-195.

4.Charles W. Cummings, Otolaryngology-HeadandNeckSurgery3rdedition, Mosby-YearBook, 1998, 2096-2129

5. Yu Ping, editor of Wang Rongguang. Voice disorders and voice surgery. Beijing: People's Military Medical Press, 2009: 102-103.