Laryngeal Vocal Nodules

Treatment options for vocal fold nodules (VFNs) and vocal fold polyps (VFPs) include both invasive and noninvasive techniques. Prevailing thought reflects the opinion that the etiologic mechanisms of both lesions are most directly related to vocal use and technique. Therefore, attention to correcting the underlying causative factors, largely through voice therapy and education, plays an integral role in any treatment plan of action.

Education regarding proper vocal hygiene and hydration and avoidance of vocal abuse, misuse, and overuse is a necessary baseline. The patient must comprehend how specific behaviors or patterns thereof may have contributed or may in the future contribute to vocal fold lesions. Intervention in the form of voice therapy to correct these usage issues may be all that is required with the vast majority of vocal fold nodules (VFNs), as well as some small vocal fold polyps (VFPs).

A prospective cohort study by Wang et al indicated that in many patients, vocal fold steroid injections are a beneficial long-term treatment for vocal fold polyps and nodules. The study involved 189 patients, including 72 with vocal fold nodules, 72 with vocal fold polyps, and 45 with mucus-retention cysts. The investigators found that after 2 years, the injections were still effective in half of the patients (although two patients were lost to follow-up by the end of the first year), including in 54%, 49%, and 43% of polyp, nodule, and cyst cases, respectively. 

As previously noted, with the exception of lesions affecting the patency of the airway or those in which the diagnosis of malignancy is entertained, the indication for surgical therapy is unacceptable vocal impairment despite compliance with medical treatment and appropriate voice therapy. Clearly, the level of acceptable vocal impairment varies widely between individuals depending on professional and personal voice usage patterns and demands.