Vocal fold polyp

Vocal folds are two horizontally running folds of tissue covered with mucous membrane that are located within the larynx and are responsible for the formation of the voice. Benign neoplasms often appear in the area of ​​these vocal folds. These can include the consequences of incorrect speech or surgical interventions with intubation, which can lead to the thickening of the vocal folds and the formation of polyps (Vocal fold polyp) can come.

What is a vocal cord polyp?

A vocal fold or also Vocal cord polyp is a benign change that occurs exclusively on the free edge of the vocal fold or on the subglottic slope of the anterior third of the vocal fold. While smaller polyps are broad-based, larger forms are spherical and stalked. 90 percent of the vocal fold polyps occur on one side only.

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A distinction is made between edematous (swelling due to the accumulation of fluid), myxomatous (made of unformed mucous and connective tissue) or telangiectatic (enlarged, small, superficial skin vessels) pseudotumors. The surfaces of vocal cord polyps are glassy, ​​smooth, spherical, and reddish in color. There are no known malignant changes in these polyps.

causes

The causes of the emergence of Vocal fold polypsthat are common in middle-aged men are unclear. It is possible that there is a connection with vocal overload. Since the polyps occur more frequently in cigarette smokers, smoking is also a possible cause. Chronic inflammation and inflammation-promoting noxae such as heat, smoke, dust, caustic vapors, etc. can also be the cause of vocal cord polyps.

Symptoms, ailments & signs

A vocal cord polyp manifests itself as hoarseness, a scratchy throat, and other voice disorders. There is also a cough, difficulty breathing and a foreign body sensation in the throat. The hoarseness is the most obvious symptom and is usually permanent. Depending on how large the polyp is and where it is located, changes in the color of the voice or even complete loss of voice can occur.

The voice of those affected often sounds rough and double-tone, although the color of the voice can vary greatly as the disease progresses. In addition, fibrous inflammation can occur near the vocal folds. These repeatedly cause shortness of breath and attacks of suffocation; in the worst case scenario, the patient can be killed.

If treatment is delayed or not received, the typical throat problems become so severe that the quality of life is severely restricted. Inflammation can lead to bacterial superinfection. Then the pathogens can spread to the surrounding body regions and, in the worst case, cause sepsis.

Blood poisoning manifests itself, among other things, by a fever and an increasing feeling of illness. Provided that therapy is rapid, the symptoms can be alleviated in a targeted manner. One to two weeks after the vocal cord polyp has been removed, patients are usually symptom-free again.

Diagnosis & course

A Vocal fold polyp can cause a more or less pronounced hoarseness or double tone of the vocal sound (diplophony). If the vocal cord polyp moves back and forth in the glottis during phonation and breathing, the intensity of the hoarseness changes again and again.

Patients can have a foreign body sensation and suffer from a dry cough or constant throat clearing. Larger polyps or vocal folds that are additionally swollen due to inflammation can even lead to attacks of suffocation.

A laryngoscopy, known as a laryngoscopy, is performed to detect changes in the tissue on the vocal folds. The doctor looks at the patient's vocal cords and larynx using a small mirror that is inserted through the mouth into the throat. Nasal endoscopy is another helpful examination method.

The nasal endoscope is a flexible thin tube. This is passed through the nostril and down into the throat. Thanks to a light source and a mini camera at the tip of the endoscope, the doctor can view the vocal folds. Small forceps can also be inserted through the endoscope, e.g. B. to take tissue samples.

Complications

Vocal fold polyps that are treated in a timely manner are usually not associated with serious complications. In the event of an unusual course or delayed treatment, the typical symptoms such as hoarseness, polyphony of the voice as well as coughing and scratching in the throat or other throat problems can intensify so much that it can temporarily lead to severe impairment or even loss of the voice.

Complications can also arise if the polyps have to be surgically removed. Although the removal of a vocal cord polyp is only a small and usually harmless procedure, certain risks cannot be completely ruled out. This can lead to heavy bleeding during or after the procedure.

Minor injuries to the mucous membranes can also result in the patient having difficulty swallowing for some time after the operation. Very many patients show hoarseness after the surgical removal of a vocal cord polyp, which in severe cases can last for several weeks.

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Inflammation of the surgical wound, on the other hand, is rare, but still possible. This can make treatment with antibiotics necessary, which is often associated with unpleasant side effects. Even after successful removal of the polyp, speech therapy may be required to fully restore the voice.

When should you go to the doctor?

A vocal fold polyp usually always requires medical treatment. Since this disease cannot heal itself and the symptoms usually continue to worsen if left untreated, a doctor should always be contacted at the first signs and symptoms of the disease.

The doctor should be consulted if the patient suffers from severe hoarseness. This can also lead to breathing difficulties, so that patients often feel tired and exhausted. Exercising strenuous activity is also usually difficult for those affected. It is not uncommon for severe shortness of breath to indicate the vocal fold polyp and must also be examined by a doctor. Most of those affected continue to have a fever and, if left untreated, blood poisoning, which can lead to death.

If you have a vocal fold polyp, you can see a general practitioner or an ENT specialist. The treatment itself is then carried out by a specialist and usually leads to success without complications.

Treatment & Therapy

Usually they are Vocal fold polyps removed by a small operation that is done with the help of an endoscope. Similar to nasal endoscopy, this is advanced through the mouth to the larynx. All the instruments necessary for the operation are located at the tip of this endoscope.

With a small forceps or with a laser, the polyp is removed from the mucous membrane under a microscopic view. This operation is also possible under local anesthesia with a special phonosurgeon. The material removed during the procedure should always be examined histologically by a specialist in order to confirm the diagnosis and to rule out a malignant tumor.

After the microsurgical removal of vocal cord polyps and after elimination of unfavorable accompanying circumstances, speech therapy voice therapy is necessary in most cases.

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prevention

As the basic causes of the emergence of Vocal cord polyps are not yet clarified, it is hardly possible to prevent this disease directly. But if some elementary things are observed, the risk of it can be reduced.

In the event of acute hoarseness, it is better to refrain from talking and anything that irritates the throat as much as possible. In addition to nicotine and alcohol, this also includes spicy foods. Clearing your throat should be avoided, as the vocal folds hit each other violently, which in the long term can lead to inflammation of the vocal folds.

People who have to use their voice a lot (singers, teachers or journalists) are particularly at risk of hoarseness and should pay particular attention to the correct use of their voice.

Aftercare

After the surgical removal of the vocal fold polyp, it is important to ensure that the patient spares his voice for about three to ten days during follow-up care.This allows the surgical wound to heal more easily and the tissue defect to regenerate better. If the patient has to speak from time to time, whispering should be avoided.

Whispering puts more stress on the vocal cords. It is therefore considered more sensible to speak in a normal tone. If bleeding occurs after the operation, it is important to contact the doctor. In addition, the patient must not have any spicy or hot meals for about a week after the surgery.

Likewise, the consumption of tobacco products and alcohol must be completely avoided while the surgical wound is healing. Especially the alcohol increases the risk of rebleeding.

If the phase of vocal rest is over, it is recommended to perform voice therapeutic exercise therapy. It is particularly advisable after vocal fold polyps that have developed for a long time, because over time it comes to solidification of vocal pressure patterns.

How long the exercise treatments of the voice have to take place depends on how the patient responds to the various exercises individually. In most cases, therapy takes about four to six weeks.

You can do that yourself

In everyday life, you should generally refrain from consuming nicotine. This has a negative impact on the health of the person concerned in various areas. It is therefore advisable to stop smoking actively and passively in good time.

Smoking does not only include the consumption of cigarettes and cigars. No pipe, shisha or e-cigarette should be smoked either. Since the smoke of the products can generally be inhaled through the air, no places should be visited where people smoke. Otherwise, the pollutants could also get into the organism via so-called passive smoking. In addition, you should avoid environments in which dust or corrosive fumes can be found in the air.

A good and healthy oxygen supply must be ensured in everyday life. Rooms should be ventilated regularly and staying outdoors is advisable. In the case of leisure activities, it is also important to note which places are visited and what the conditions there are.

As soon as complaints of the vocal environment are perceived, speaking should be avoided if possible. Communication is to be kept to a minimum. It is advisable to protect the neck by wearing items of clothing such as a scarf or a loop. The person affected should protect himself adequately with these accessories, especially when the season changes or in cold environments.