What is a Vocal Cord Granuloma?

A vocal cord granuloma is a growth of benign inflammatory tissue, usually on the posterior 1/3 of the vocal cord. It is caused by local trauma to the vocal cord from coughing, vocal abuse, or direct mechanical trauma from a breathing tube or surgery.

Symptoms

Granulomas cause pain that can be felt when speaking, laughing, coughing, or singing. They can cause hoarseness or breathiness because they prevent complete closure of the vocal cords. They can also cause a sensation that there is something “stuck” in the throat.

Treatment

Granulomas may be treated with inhaled steroids, injected steroids (yes you would be asleep for that!) or a special laser to dry up the inflamed tissue and prevent its recurrence. They may be treated with speech therapy or behavioral modification if on evaluation the speech therapist suspects vocal abuse.

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Are Granulomas Cancer?

Granulomas are rarely malignant. Tissue sampling, or a biopsy,  done during surgery can tell whether a granuloma is cancerous or not.

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What is Vocal Cord Paralysis?

Vocal cord paralysis can be caused by neck or chest surgery, by benign or malignant growths near the nerve to the vocal cord, by bacterial or viral infections, by certain types of chemotherapy, or by trauma. The trauma may be a neck trauma, a blunt injury to the larynx, or caused by a breathing tube. The vocal cords normally open wide when you breathe to let air into your lungs, and then they come to the midline when you speak in order to compress the air flowing from your lungs and cause high frequency vibration of their cover. It is this vibration that makes the sound waves that create the base for your voice.

Symptoms

If one vocal cord is weak and cannot come to the midline, the result is a fatter stream of air that moves more slowly. The voice is usually breathy, weak, and difficult to project. The speaker may feel fatigue after speaking for only a few minutes. In severe cases, very little sound comes out. The surgery to restore voice can be a temporary filler injection that “spints” the vocal cord in cases where the doctor expects the voice to recover, or in cases where recovery is not expected, a permanent implant may be needed to move the vocal cord into a position where the other vocal cord can meet it to create voice.

Treatment

If the permanent type of surgery is necessary, a small external incision (usually one inch in length) is used to insert the implant. The GoreTex surgical fabric implant has been used with vocal cord paralysis patients for over 25 years in cardiovascular surgery, it’s customizable to the shape of each patient’s vocal cord, well tolerated by the body, and does not get infected. The success rate for getting a normal voice is 98%. Very rarely if the paralysis is complete and there is atrophy (wasting or shrinking) of the muscles of the vocal cord over time, more graft material may be required to maintain the mid-line position of the paralyzed side. Usually though one surgery is sufficient and permanent.

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Vocal Cord Polyp

What is a Vocal Cord Paralysis?

A polyp on the vocal cord usually comes from trauma to the edge of the vocal cord. It is similar to a blister but instead of thin fluid it is filled with a jelly-like substance. Typically these arise from hard singing, raising of the voice, excessive voice use, coughing, or sneezing. Hemorrhagic polyps occur when there is a broken blood vessel on the edge of the vocal cord; these appear red on exam like a blood blister. Both types cause hoarseness by interfering with the normal closure and vibration of the vocal cords.


Treatment

Polyps need to removed with a very precise surgery using an operating microscope. Tiny instruments are used to carefully remove the polyp while preserving all of the normal underlying tissue. Often speech therapy will also be recommended to eliminate bad vocal habits or technique that may have caused the polyp. It is very important to not use the voice for one week after the polyp removal to allow the vocal cord to heal properly.


Can Polyps be Cancerous?

Some lesions on the vocal cord that look like polyps are occasionally other growths, such as warts (papillomas) or precancers or even cancers. Tissue sampling is important to prove that a polyp is not cancerous. This is done at the time of removal of the polyp.

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