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Describe the benign lesions of the vocal cords.

ENT · 3rd Professional

Benign Lesions of the Vocal Cords

Benign vocal cord lesions arise chiefly in REINKE’S space, the loose superficial layer of the lamina propria.
They are largely the result of voice abuse, smoking and reflux, and most are preventable and many are treatable without surgery.

Lesion	Features and management
Vocal nodules (singer nodes)	Bilateral, symmetrical, at the junction of the anterior and middle thirds — the point of maximum vibration and impact. Occur in habitual voice abusers, teachers, singers and shouting children. Treatment is speech therapy and voice hygiene.
Vocal polyp	Unilateral, pedunculated or sessile, at the same site. Frequently follows a single episode of severe voice abuse or a shout, and may be haemorrhagic. It does not resolve with therapy and requires microsurgical excision
REINKE oedema (polypoid degeneration)	Diffuse, bilateral, gelatinous swelling of the whole cord. Almost always in a smoker, characteristically a middle-aged woman, giving a strikingly deep, masculine voice. Stopping smoking is essential and may suffice; surgery is microflap reduction, and relapses if smoking continues
Vocal cyst	Unilateral, within the cord, mucous retention or epidermoid. Causes persistent hoarseness that fails to respond to speech therapy. Needs microsurgical excision preserving the ligament
Contact granuloma	On the vocal process of the arytenoid (posterior, unlike the others). Caused by reflux, intubation and throat clearing. Treated by reflux therapy, voice therapy and stopping the habit; surgery has a high recurrence rate and is a last resort
Sulcus vocalis	A longitudinal groove with loss of the superficial lamina propria, causing a persistently breathy, weak voice and a DAMPED mucosal wave. Difficult to treat and easily missed without stroboscopy
Leukoplakia	A white patch that is premalignant and must be biopsied. Stop smoking, treat reflux, and follow up

The common thread is that these lesions are caused by mechanical trauma to a delicate layered structure.
Assessment — videostroboscopy, which is essential, since it distinguishes a nodule from a cyst, reveals a sulcus, and assesses the mucosal wave in ways a still endoscopic view cannot
Voice assessment and recording before and after treatment
Principles of management:
Speech therapy first for nodules, muscle tension and contact granuloma
Stop smoking, which is indispensable in Reinke oedema and leukoplakia
Treat reflux, particularly for granuloma and posterior laryngitis
Voice hygiene — hydration, avoiding shouting, whispering and throat clearing, amplification for teachers

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