Treatment of Vocal Cord Polyps
For vocal cord polyps, initial conservative management with voice therapy should be attempted first, but laryngeal microsurgery remains the definitive treatment when conservative measures fail or for larger lesions, with pre-surgical voice therapy enhancing ultimate outcomes. 1, 2
Initial Assessment and Diagnosis
- All patients with dysphonia lasting beyond 2-4 weeks require laryngeal examination to visualize the polyp and rule out malignancy 1
- Expedited laryngeal evaluation is particularly critical for smokers, as smoking is associated with increased risk of polypoid vocal fold lesions and malignancy rates of 15-24% 1
- Highly suspicious lesions with increased vascularity, ulceration, or exophytic growth require prompt biopsy to exclude malignancy 1
- For superficial lesions on mobile vocal folds, a trial of conservative therapy with avoidance of irritants may be employed prior to biopsy 1
Treatment Algorithm
First-Line: Conservative Management with Voice Therapy
Voice therapy alone can improve voice quality and should be the initial treatment approach for most vocal cord polyps. 1, 2
- Voice therapy improves symptoms in approximately 60% of patients and can avoid surgery in up to 80% of cases 3
- Specific techniques include sonorous lips and tongue trill exercises, performed for 30-45 minutes per session over 10 weeks 3
- Conservative management should include vocal hygiene education, avoidance of phonotrauma, and treatment of contributing factors (reflux, allergies) 1
- Factors predicting better response to voice therapy alone include: young age, small polyp size, and short duration of dysphonia 2
When Surgery is Indicated
Surgery is reserved for polyps that fail conservative management or when satisfactory voice cannot be achieved with therapy alone. 1
Specific indications for proceeding to surgery:
- Failure of voice therapy after 8-10 weeks of treatment 2, 3
- Large polyps (>1 cm) that significantly obstruct the glottis 2
- Professional voice users requiring rapid return to optimal function 1
- Patient preference after informed discussion of risks and benefits 1
Optimal Surgical Approach
- Laryngeal microsurgery is the standard surgical treatment for vocal cord polyps 1, 4
- Surgery can improve both subjective voice-related quality of life and objective vocal parameters 1
- Pre-surgical voice therapy followed by surgery (combined approach) produces significantly greater improvement in voice outcomes than surgery alone 2
Critical Management Principles
The Combined Approach Advantage
- Patients who receive voice therapy before surgery demonstrate superior outcomes in:
- This combined approach addresses both the structural lesion and underlying vocal behaviors that contributed to polyp formation 2
Common Pitfalls to Avoid
- Do not delay laryngeal examination beyond 2-4 weeks of persistent dysphonia, especially in smokers where malignancy risk is substantial 1
- Avoid proceeding directly to surgery without attempting conservative management in appropriate candidates, as this misses the opportunity for non-invasive resolution 1, 2
- Do not neglect post-operative voice therapy, as failure to address underlying vocal behaviors may lead to recurrence 1
- Smoking cessation is essential - continued smoking worsens outcomes and increases recurrence risk 1
Special Populations
- Professional voice users (teachers, singers, public speakers) warrant early evaluation and may require expedited treatment due to occupational impact 1
- Pediatric vocal polyps are rare and typically managed conservatively, as they often resolve during normal development 1
- For elderly patients with large polyps requiring surgery, specialized airway management may be necessary 5