While small, your vocal cords are a vital part of your body. They’re the mechanism that allows us to use our voice -- to speak and communicate.  These two muscular bands inside the throat, about the size of a thumbnail, open when you speak, gently coming together to produce sound. As you talk, they rub against one another and create the pitch of your voice. 

Unfortunately, your vocal cords can develop lesions from this rubbing, which may require treatment. 

Vocal cord lesions

“If you have high vocal demands, medical comorbidities or lack adequate breath support, you can end up squeezing too much with the muscles that bring the vocal cords together and cause irritation, creating lesions,” says speech and language pathologist Amber Koch, MS CCC-SLP. “These lesions can occur from extended use or even a single event like an aggressive scream or from singing loudly.”

Types of vocal cord lesions include:

• Nodules.
• Polyps.
• Cysts.

Nodules vs. polyps: what’s the difference?

Nodules are like calluses that form when the vocal cords swell and harden. If left untreated, these nodules can increase in size and stiffness. Additionally, they’re usually on both vocal cords.

Polyps, on the other hand, are swollen spots or lumps that can occur on one or both vocal cords. Typically, they’re also larger than nodules and more like a blister.

How do vocal cord nodules and polyps develop?

“There are certain occupations or personality types that may predispose a person to have a vocal polyp or nodule,” says Koch. “Those with a high voice demand at work, like teachers or litigation attorneys, or simply those who talk a lot, may have a higher chance of developing these vocal lesions.”

But it’s not always about poor technique. “Sometimes, a person’s anatomy can’t keep up with the physical demands because their vocal cords are delicate,” says Koch. “Once the skin on the vocal cords begins to thicken or irritate, we compensate by squeezing the vocal cords more, which perpetuates those lesions.”

Symptoms of vocal nodules or polyps

Watch for these common symptoms:

• A feeling of something stuck in your throat.
• A change in vocal quality.
• Excess mucus that’s difficult to clear.
• Irritation.

Treatments for vocal nodules or polyps

First, every patient needs a thorough evaluation from an ear, nose and throat provider, preferably a laryngologist. “We have two fellowship-trained laryngologists at Nebraska Medicine,” says Koch.

This evaluation will include a detailed medical history to understand why you’ve developed these lesions, if any medical comorbidities could predispose you to have them or if any recent event or procedure could have played a role in their development. 

Finally, it’s essential to get imaging of the airway. “This imaging is vital because it helps surgeons decide whether or not the nodule or polyp requires surgery,” says Koch. If the lesion is big enough, it may need surgical removal. If it isn’t, the patient will undergo vocal cord therapy.

What is voice therapy?

If surgery isn’t needed, voice therapy is the next step. It begins with an evaluation by a speech and language pathologist. 

“My job is to understand if people are a therapy candidate, to ensure it will be beneficial; that there’s a potential for change from therapy,” says Koch.

Vocal cord therapy focuses on:

• Properly hydrating the airway.
• Relaxation techniques for overused muscles.
• Training patients to use their vocal cords more gently.

“Some people need to learn how to talk in a different way,” says Koch. “Whereas others, with less complex cases, simply need to increase their throat health so the skin can heal. Either way, we’re diligent about monitoring every patient to ensure therapy is helping them.”

Preventing vocal cord nodules or polyps

If you feel you’ve strained your voice, rest is important.  Any longstanding vocal cord concern, especially after a viral or upper respiratory infection, is critical to note. If such an illness changes your voice and doesn’t improve, you should see a doctor. You shouldn’t tolerate any difficulty with vocal quality or discomfort for very long.

“The sooner we catch these lesions, the easier they are to treat,” says Koch. “When people wait for a long time, then muscle memory becomes ingrained, people begin to squeeze their throat more, which perpetuates lesions.” Fighting such muscle memory makes vocal cord lesions harder to treat because you’re usually not aware of it, making it more difficult to correct during treatment.

Finally, if you have an upcoming day or week of high voice demand, it's vital to: 

• Hydrate properly by drinking plenty of water.
• Avoid dehydrating substance like coffee or alcohol.
• Use a humidifier to improve vocal cord hydration.
• Avoid mentholated products like cough drops or vapor rub (they can dry out your mucosa and further irritate your vocal cords).

Don’t wait to treat vocal cord nodules or polyps

Numerous home remedies for vocal lesions are available online. However, patients should approach these treatments cautiously. “We’re still learning a ton about the throat, and there’s little research supporting some of these homeopathic remedies,” says Koch.

Children can develop vocal cord nodules and polyps as well. So, make sure your children are evaluated if they’re experiencing vocal strain. “Kids use their voice in big ways, and you don’t want them to perpetuate any habits that could negatively impact their throat health down the road,” says Koch.

Evaluation and treatment are essential for anyone experiencing vocal strain, regardless of whether they are a child or an adult. “Repeatedly straining your voice is a very big problem, and being evaluated and figuring out the problem sooner rather than later makes treatment a lot easier.”