Treatment for Vocal Cord Polyps
Vocal cord polyps should be initially treated with conservative management including voice therapy, with surgery reserved only for cases that fail to achieve satisfactory voice improvement after an adequate trial of behavioral intervention. 1
Initial Conservative Management
A trial of conservative management is typically recommended prior to surgical intervention and may eliminate the need for surgery entirely. 1 The American Academy of Otolaryngology-Head and Neck Surgery emphasizes that many benign phonotraumatic vocal fold lesions, including polyps, are self-limited or reversible. 1
Voice Therapy as First-Line Treatment
- Voice therapy is effective across the lifespan and should be the primary initial treatment approach. 1
- Treatment typically consists of 1-2 therapy sessions weekly for 4-8 weeks with a certified speech-language pathologist. 2
- Voice therapy aims to eliminate harmful vocal behaviors, shape healthy vocal behavior, assist in vocal fold wound healing, and help patients compensate for altered laryngeal physiology. 2
- Specific techniques such as "Voice Therapy Expulsion" training and sonorous lips and tongue trill exercises have demonstrated effectiveness in treating vocal polyps, with success rates of 60-80% in avoiding surgery. 3, 4
Adjunctive Conservative Measures
- Adequate hydration is essential to maintain vocal fold health. 2
- Avoidance of irritants such as tobacco and alcohol is recommended. 2
- Appropriate vocal rest to prevent further strain should be implemented. 2
- Patient education about vocal hygiene and behavioral modifications is critical. 1
Surgical Intervention
Surgery is reserved for benign vocal fold lesions when a satisfactory voice result cannot be achieved with conservative management and the voice may be improved with surgical intervention. 1
Indications for Surgery
- Symptomatic benign vocal fold lesions not responsive to conservative management. 1
- Failure to achieve adequate voice improvement after an appropriate trial of voice therapy (typically 6-8 weeks). 3, 4
- Patient preference after informed discussion of risks and benefits. 3
Surgical Approach
- Endolaryngeal microsurgery (phonomicrosurgery) is the standard surgical approach for vocal fold polyp removal. 3, 5
- Surgery can improve subjective voice-related quality of life and objective vocal parameters among patients with dysphonia resulting from benign vocal fold lesions. 1
Combined Treatment Approach
Pre-surgical voice therapy enhances the ultimate success of treatment and should be considered even when surgery is planned. 6, 5
- Patients receiving preoperative voice therapy demonstrate significantly better postoperative voice outcomes compared to surgery alone, particularly in breathiness and jitter parameters. 6
- Voice therapy is beneficial when combined with other treatment approaches, including pre- and postoperative therapy. 1
- The combination of surgery and voice therapy is more effective than either modality alone, with the greatest improvements in voice quality, Voice Handicap Index scores, and stroboscopy findings. 5
Factors Affecting Treatment Response
Certain patient characteristics predict better response to conservative voice therapy alone: 5
- Younger age
- Smaller polyp size
- Shorter duration of dysphonia
Critical Pitfall to Avoid
Failure to address underlying etiologies (such as vocal abuse patterns, reflux, or irritant exposure) may lead to postsurgical recurrence of polyps. 1 This underscores why voice therapy—either alone or combined with surgery—is essential for long-term success rather than surgery as an isolated intervention.
Pediatric Considerations
In the pediatric population, vocal polyps and nodules typically resolve over time during normal developmental processes, and voice therapy should be considered the primary treatment. 1, 7 Surgery has a limited role and should be reserved for severe cases refractory to conservative treatment. 1, 7