Benign Vocal Fold Masses

The voice is not only a vital tool for communication but also a significant part of our identity. When issues arise that affect the voice, they can impact every aspect of our lives—from our ability to work to our social interactions and overall quality of life.

One of the common issues that can disrupt vocal function is the presence of benign vocal fold masses. These masses, though non-cancerous, can significantly affect voice quality and cause various symptoms that may lead individuals to seek medical advice. In this comprehensive guide, we will explore what benign vocal fold masses are, their causes, symptoms, diagnosis, and the treatment options available.

What Are Benign Vocal Fold Masses?

Benign vocal fold masses are non-cancerous growths or lesions that develop on the vocal cords (vocal folds). These masses can vary in size, shape, and consistency, and they often interfere with the normal vibration of the vocal folds, leading to voice changes and other symptoms.

What Are the Types of Benign Vocal Fold Masses?

Several types of benign vocal fold masses exist, each with distinct characteristics. The most common types include:

Vocal Fold Nodules

Description: Also known as "singer's nodules" or “teacher’s nodules” these are small, symmetrical, callous-like growths that typically form on both vocal folds. They are often caused by chronic vocal strain.

Symptoms: Nodules usually cause a hoarse, breathy voice and may result in vocal fatigue. The voice often improves with rest but worsens with prolonged use.

Vocal Fold Polyps

Description: Polyps are usually larger than nodules and can appear on one or both vocal folds. They are usually soft, fluid-filled, and can vary in size. Polyps often result from acute vocal trauma or irritation.

Symptoms: Polyps typically cause a hoarse voice, and if large enough, they can even obstruct the airway, making breathing difficult.

Vocal Fold Cysts

Description: Cysts are small, fluid-filled sacs that form within the vocal fold tissue. They are usually deeper than nodules or polyps and can be congenital (present at birth) or acquired.

Symptoms: Vocal fold cysts can cause a persistent hoarse voice that does not improve with rest. They may also cause a rough or breathy voice.

Reinke’s Edema

Description: This condition involves the swelling of the vocal folds due to fluid accumulation within the superficial layer of the vocal fold (Reinke's space). It is commonly associated with smoking and vocal abuse for a long period of time.

Symptoms: Reinke's edema typically causes a low-pitched, husky voice and can make breathing noisy or difficult.

Granulomas

Description: Granulomas are inflammatory masses that often develop on the back part of the vocal folds, typically as a result of irritation from laryngopharyngeal reflux (LPR), habitual throat clearing or after prolonged intubation.

Symptoms: Granulomas can cause throat pain, hoarseness, and a sensation of something being stuck in the throat.

Papillomas

Description: Caused by the human papillomavirus (HPV), papillomas are wart-like growths that can appear anywhere on the respiratory tract. Their most common location is on the vocal folds. They tend to recur and may spread to other areas of the airway. For this reason, the disease related to this conditon is called the “recurrent respiratory papillomatosis”.

Symptoms: Papillomas often cause hoarseness and a breathy voice. and Breathing may be difficult if they obstruct the airway.

Causes of Benign Vocal Fold Masses

The development of benign vocal fold masses can be attributed to several factors, depending on the type of mass. Here are some common causes:

Vocal Overuse and Abuse: Prolonged or excessive use of the voice, particularly in individuals who use their voice professionally (e.g., singers, teachers, public speakers), can lead to the formation of nodules and polyps. Shouting, yelling, or speaking at an unnatural pitch can also contribute.

Acute Vocal Trauma: Sudden vocal strain, such as that caused by shouting at a concert or cheering at a sports event, can lead to the development of polyps or hemorrhages on the vocal folds.

Chronic Irritation: Conditions that cause chronic irritation of the vocal folds, such as smoking, exposure to environmental irritants, or laryngopharyngeal reflux, can lead to Reinke’s edema, granulomas, or papillomas.

Infections: Viral infections, particularly those caused by the human papillomavirus (HPV), can result in the formation of papillomas on the vocal folds.

Congenital Factors: Some individuals are born with congenital cysts on their vocal folds. These cysts may become symptomatic later in life as they interfere with normal vocal function.

Symptoms of Benign Vocal Fold Masses

The symptoms of benign vocal fold masses vary depending on the type, size, and location of the mass. Common symptoms include:

Hoarseness: One of the most common symptoms, hoarseness occurs when the vocal folds cannot vibrate properly due to the presence of a mass. The voice may sound rough, breathy, or raspy.

Vocal Fatigue: Individuals with benign vocal fold masses may experience vocal fatigue, especially after prolonged speaking or singing. The voice may weaken or fade as the day progresses.

Breathy Voice: A breathy voice occurs when the vocal folds cannot close completely, allowing air to escape during speech. This can result in a weak or airy voice.

Pitch Changes: Some masses, such as Reinke’s edema, can cause a deepening of the voice. Others may make it difficult to reach high notes, especially in singers.

Voice Breaks: The presence of a mass can cause unpredictable voice breaks or cracking, particularly when trying to change pitch or volume.

Throat Pain or Discomfort: Granulomas and other inflammatory masses can cause pain or a sensation of something being stuck in the throat.

Difficulty Breathing: In rare cases, large masses or multiple papillomas can obstruct the airway, leading to noisy breathing or shortness of breath.

Diagnosis of Benign Vocal Fold Masses

Accurate diagnosis is crucial for effective treatment. The diagnostic process typically involves a combination of patient history, physical examination, and specialized tests.

Patient History

During the initial consultation, I take a detailed patient history to understand the nature of the symptoms, their onset, and any potential contributing factors such as vocal habits, smoking, systemic diseases, medications used, frequency of alcohol consumption or acid reflux. This information helps guide the diagnostic process.

Endoscopic Laryngeal Examination (Laryngoscopy)

Laryngoscopy is a key diagnostic tool used to visualize the vocal folds. There are two main types of laryngoscopes, flexible or rigid ones. A flexible or rigid endoscope with a light and camera is inserted through the nose or mouth to provide a clear view of the vocal folds. This allows for real-time observation of the vocal folds during speech and breathing.

Stroboscopy

Stroboscopy is a specialized form of laryngoscopy that uses a strobe light to create a slow-motion view of the vocal fold vibrations. This technique is particularly useful for assessing how a mass affects vocal fold movement and vibration. This state-of-art techniques may be used via a rigid or a distal chipped flexible endoscope in today’s technology.

Imaging Studies

Although imaging studies such as ultrasound, computerized tomography scan or magnetic resonance imaging are useful for many diseases, they are very rarely needed while we are dealing with benign vocal fold pathologies. Thier most common use in vocal fold pathologies is to evaluate the distrbution and depth of a malignant vocal fold pathology.

Biopsy

If there is any concern that a mass may be malignant, a biopsy may be performed to obtain a tissue sample for analysis. This is usually done under general anesthesia during a laryngoscopy.

Treatment of Benign Vocal Fold Masses

The treatment of benign vocal fold masses depends on the type, size, and severity of the mass, as well as the patient’s vocal needs and overall health. Treatment options range from conservative management to surgical intervention.

Voice Therapy

Voice therapy, conducted by a specialized speech-language pathologist, is most commonly the first line of treatment for benign vocal fold masses, especially for nodules. The goal of voice therapy is to modify vocal habits, reduce strain, and promote healing. Techniques may include but definitely not limited to:

Vocal Hygiene Education: Teaching patients how to take care of their voice, including proper hydration, avoiding irritants, and using good vocal techniques.

Vocal Exercises: Exercises designed to strengthen the vocal folds and improve their function.

Behavioral Modification: Helping patients identify and change harmful vocal behaviors, such as throat clearing, yelling, or speaking at an inappropriate pitch.

Voice therapy can be particularly effective for small nodules and polyps, and it may prevent the need for surgery in some cases.

Medical Management

For conditions like Reinke’s edema or granulomas, addressing the underlying cause is essential. Medical management may include:

Medications: Proton pump inhibitors (PPIs) or H2 blockers may be prescribed to manage acid reflux, which can contribute to the formation of granulomas.

Smoking Cessation: Smoking cessation programs and nicotine replacement therapy can help patients quit smoking, which is especially crucial for managing Reinke’s edema.

Allergy Management: For patients with allergies that cause chronic throat clearing or irritation, antihistamines or allergy shots may be recommended.

Surgical Intervention

When voice therapy and medical management are insufficient, or when the mass significantly interferes with vocal function, surgical removal may be necessary. The type of surgery depends on the nature of the mass. The surgery is defined as “microlaryngoscopy” or “phonomicrosurgery”. It is performed under general anesthesia using a laryngoscope and specialized microsurgical instruments including lasers as well.

Postoperative Care and Voice Rehabilitation

After surgery, voice rest is essential to allow the vocal folds to heal. Patients are usually advised to avoid speaking, whispering, or any vocal activity for a specified period, typically ranging from a few days to a week.

Following the initial healing period, voice therapy is often recommended to help patients gradually return to normal voice use and prevent recurrence of the mass. Rehabilitation may include:

Gradual Reintroduction of Voice Use: Starting with simple vocal exercises and gradually increasing vocal demands.

Monitoring and Follow-Up: Regular follow-up appointments to monitor healing and address any concerns or complications.

Long-Term Management: For some conditions, such as papillomatosis, which can recur, long-term management is necessary. Patients may require periodic monitoring and additional treatments to manage the condition over time.

## Conclusion

Benign vocal fold masses, though non-cancerous, can have a significant impact on vocal function and quality of life. Understanding the different types of masses, their causes, symptoms, and treatment options is crucial for anyone experiencing voice changes or other related symptoms.

At the International Voice Clinic, we are committed to providing comprehensive care for individuals with vocal fold disorders. Our team of specialists, including experienced laryngologists and speech-language pathologists, work together to develop personalized treatment plans that address each patient’s unique needs.

If you are experiencing voice problems or have been diagnosed with a benign vocal fold mass, we encourage you to seek a consultation with our expert team. Early diagnosis and appropriate treatment are key to restoring your voice and preventing further complications. Your voice is an invaluable asset—let us help you protect and preserve it.

This guide on benign vocal fold masses is designed to educate and inform patients and their families about the importance of vocal health, the conditions that can affect the vocal folds, and the treatment options available. At the International Voice Clinic, our mission is to provide the highest standard of care, helping patients achieve the best possible outcomes and improve their quality of life.