What is the treatment for crusted vocal cords?

Treatment for Crusted Vocal Cords

Voice therapy is the first-line treatment for crusted vocal cords, with surgical intervention reserved for cases that don't respond to conservative management. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis through laryngoscopy is essential:

• Laryngoscopy should be performed when dysphonia (voice alteration) fails to resolve within 4 weeks or if a serious underlying cause is suspected 1
• Diagnostic laryngoscopy should be performed before prescribing voice therapy, with results documented and communicated to the speech-language pathologist (SLP) 1
• Crusted vocal cords may appear as circumscribed lancet-shaped ulcerations in the middle third of the vocal fold 2

Treatment Algorithm

1. Conservative Management (First-Line)

• Voice therapy: 1-2 sessions weekly for 4-8 weeks 1

  • Consists of tasks designed to eliminate harmful vocal behaviors
  • Shapes healthy vocal behavior
  • Assists in vocal fold wound healing
  • Should be conducted by certified and licensed speech-language pathologists 1

• Hydration and vocal hygiene measures:

  • Adequate fluid intake
  • Humidification
  • Avoidance of vocal irritants (smoking, excessive talking, throat clearing)
  • Patient education on preventive measures 1

2. Medical Management

• Avoid unnecessary medications:

  • Do not routinely prescribe antibiotics for dysphonia 1
  • Do not prescribe antireflux medications without visualization of the larynx 1
  • Do not routinely prescribe corticosteroids prior to visualization of the larynx 1

• For prolonged ulcerative laryngitis:

  • Biopsies should be avoided as the condition appears to be self-limiting 2
  • Close laryngoscopic follow-up is recommended 2

3. Surgical Intervention (For Refractory Cases)

Surgical management is indicated for:

• Symptomatic benign vocal fold lesions not responsive to conservative management
• Suspected malignancy
• Recurrent respiratory papillomatosis
• Glottic insufficiency 1

Surgical approaches include:

• Microsurgical removal of lesions
• Injection laryngoplasty for glottic insufficiency 1, 3
• Laryngeal framework surgery for permanent correction 1

Special Considerations

Monitoring and Follow-up

• Document resolution, improvement, or worsening of symptoms after treatment 1
• Assess changes in quality of life following intervention 1
• For prolonged ulcerative laryngitis, close laryngoscopic follow-up is essential 2

Common Pitfalls to Avoid

1. Misdiagnosis: Vocal cord dysfunction can mimic asthma, leading to inappropriate treatment 4, 5
2. Premature biopsy: For benign-appearing lesions, conservative management should be tried first 2
3. Inadequate laryngeal examination: Failure to perform laryngoscopy can lead to missed diagnoses 1
4. Overlooking underlying causes: Chronic laryngitis may be related to reflux, smoking, or other factors 6

Insurance Coverage

• Medicare generally covers voice therapy if provided by a certified SLP, ordered by a physician, and deemed medically necessary 1
• Medicaid coverage varies by state but generally covers voice therapy up to age 18 1
• Private insurance policies vary; patients should contact their insurance company for specific guidelines 1

Prognosis

With appropriate treatment, most cases of crusted vocal cords and dysphonia improve significantly. The condition appears to be self-limiting without permanent structural consequences when properly managed 2. Voice therapy has been demonstrated to be effective for dysphonia across the lifespan from children to older adults 1.