polyp

General

As vocal cord polyps (or vocal cord polyps) refers to a benign change (a benign tumor ), which is located on the vocal fold.

These polyps always form on the free edge of the vocal cord or on the subglottic exit (corresponding to the area under the glottis) of the anterior third of the vocal fold. In most cases, there is a vocal cord polyp at the transition from the anterior to the middle third. In about 90% of those affected, a vocal cord polyp occurs on only one side.

Appearance of vocal fold polyps

Vocal fold polyps can look very different.
They are either

  • reddish and vascular (you can see partially small bluish veins in the polyp, what you then call teleangiektatisch ) or
  • glassy translucent, in which case one speaks of a jelly polyp .

Also in size, vocal fold polyps can vary widely. Mostly, they are rather small and the vocal cord is broad-based, but there are also larger polyps, which are spherical and petiolate.

So far, no malignant degeneration of the benign vocal cord polyps has been described. When examining a vocal cord polyp under the microscope (a histological examination), one can see an enlargement of the tissue, which is due to an increase in the number of cells ( hyperplasia ). This hyperplasia affects the mucosa and is the response to inflammation. It can either have an angioma or fibroma-like structure, or it can be a true fibroma (benign tumor).

Causes of emergence

Why it comes to the formation of a vocal fold polyp, could not be clarified until today.

It is noticeable, however, that they occur more frequently in middle-aged men. In addition, there seem to be other risk factors:

  • smoking cigarettes
  • a permanent heavy burden on the voice (as it occurs, for example, with teachers or singers)

symptoms

Patients with a vocal fold polyp are most often affected by hoarseness. This hoarseness can either persist or occur only temporarily. This is especially the case when the vocal cord polyp is built so that it can shift depending on the position of the vocal folds.

For example, it is possible for larger polyps to "slip" into the area under the glottis and not cause discomfort in this position. Hoarseness usually disappears after coughing or hawking in this type of polyp. Straight, but not exclusive, in such patients is often a Räusperzwang ago. In addition, a so-called diplophony may exist, so a double tone of the vocal sound.

Some patients also describe a foreign body sensation in the throat, which, just like the hoarseness, can decrease and increase in intensity and is present either permanently or only intermittently. The larger an existing vocal fold polyp, the sooner it can come to a more or less restricted breathing up to an asphyxia.

diagnostics

The diagnosis of a vocal fold polyp is made by laryngoscopy, in which the ENT specialist can directly or indirectly view and assess the vocal folds and glottis.

A vocal cord polyp then provides him with the typical findings described above. In smaller polyps, however, it is sometimes difficult to differentiate them from vocal cord nodules or vocal fold cysts. Other important differential diagnoses include the contact and the intubation granuloma, which represent a node-like, inflammation-related tissue regeneration.

Treatment of vocal fold polyps by surgery

Although there is no risk of malignant degeneration of a vocal fold polyp, these changes are surgically removed because of their symptoms.

This ablation is performed microsurgically during a direct or indirect laryngoscopy (laryngoscopy), the direct laryngoscopy is preferred because it is gentle on the vocal cord. Through the mouth, the surgical laryngoscope is introduced and from the point of view of the vocal folds, the polyp can be removed either with the help of small instruments (such as a double spoon or small forceps) or a laser device. This operation is usually performed under general anesthesia; specialist phonosurgical surgeons rarely have polyps removed under local anesthesia.

In each case, the tissue removed is subsequently examined histologically to ensure the diagnosis, which means that the tissue is specially assessed under the microscope. After a successful procedure, the patient is cured and the symptoms have disappeared. To a new vocal fold polyp (relapse) occurs only in very few exceptions.

Risks of surgery

Since removal of the vocal cord polyp is a minor procedure, complications rarely occur. But like any other procedure, microsurgical removal of the vocal fold polyp involves risks.
Bleeding may occur during and after surgery. In addition, dysphagia is not uncommon as it leads to small injuries of the mucous membranes. Pain after the procedure, which should disappear after a few days, rarely occurs. Another risk that affects nearly all patients after vocal cord liposuction is hoarseness. This may persist due to possible swelling of the vocal cords in some cases up to four weeks after surgery. Very rarely the area ignites, where the polyp was removed. If bacteria have entered the wound, treatment with antibiotics must be given.

Aftercare after the operation

After endoscopic removal of the vocal cord polyp patients should not speak for three days. If necessary, a whispering should be avoided, as whispering puts more stress on the vocal folds. Patients should speak at a normal volume. If rebleeding occurs, seek medical attention. In addition, should be dispensed hot and spicy food for about a week. Smokers should also stop smoking for at least a week, preferably longer, because cigarette smoke negatively affects and slows wound healing.

speech therapy

After removal of the vocal cord polyp, the sound of the voice is often impaired. Therefore, most patients post-procedure are recommended to have a speech and language training vocoploic language training.
These logopedic exercises should be started as early as possible so that the muscles that are important for the language process do not regress. After successful completion of the vocal training, the voice of most patients is as before the procedure.


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