What is the treatment for a polyp on the voice box?

Treatment for Vocal Fold Polyps

Voice therapy should be the initial treatment for vocal fold polyps, with surgery reserved only for cases that fail to achieve satisfactory voice improvement after an adequate trial of conservative management. 1

Initial Conservative Management Approach

All patients with vocal fold polyps must begin with voice therapy before considering surgical intervention. 1 The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends this approach because many benign phonotraumatic vocal fold lesions, including polyps, are self-limited or reversible with conservative treatment alone. 1

Voice Therapy Protocol

• Therapy consists of 1-2 sessions per week for 4-8 weeks, delivered by a certified and licensed speech-language pathologist. 2
• The primary goals are to eliminate harmful vocal behaviors, shape healthy vocal behavior patterns, assist in vocal fold wound healing, and help patients compensate for altered laryngeal physiology. 1
• Research demonstrates that approximately 9.7% to 49% of vocal fold polyps resolve completely with voice therapy alone, with an additional proportion showing significant lesion shrinkage. 3, 4

Factors Predicting Success with Conservative Treatment

Polyps more likely to respond to voice therapy alone include:

• Translucent polyps (81.8% response rate versus 15.4-25% for fibrotic, hyaline, or hemorrhagic polyps) 3
• Smaller polyps 4
• Shorter duration of symptoms 4
• Female patients 4
• Recent onset (mean resolution time of 5.1 months) 4

Essential Adjunctive Measures

• Adequate hydration to maintain vocal fold health 1
• Complete avoidance of tobacco and alcohol, as these are vocal irritants 1
• Reduction of excessive musculoskeletal tension in the head, neck, shoulders, face, and mouth 2
• Patient education about vocal hygiene and behavioral modifications 1

Surgical Intervention

Surgery is indicated only when satisfactory voice results cannot be achieved with conservative management and the voice may be improved with surgical intervention. 1

Specific Indications for Surgery

• Failure of voice therapy after adequate trial (minimum 4-8 weeks of committed patient participation) 2
• Persistent voice-related quality of life impairment despite conservative treatment 2
• Fibrotic, hyaline, or hemorrhagic polyps that are less likely to respond to conservative treatment 3

Surgical Outcomes

• Surgery can improve both subjective voice-related quality of life and objective vocal parameters among patients with dysphonia resulting from benign vocal fold lesions. 1
• Pre-surgical voice therapy enhances ultimate surgical success, with patients receiving voice therapy before surgery (Group VTpS) showing significantly greater improvement in voice quality scores compared to surgery alone. 5

Important Clinical Considerations

When to Expedite Laryngeal Evaluation

Immediate escalation to otolaryngology is warranted for:

• History of tobacco abuse (smoking is associated with increased risk of polypoid vocal fold lesions and 15-24% prevalence of malignancy) 6
• Professional voice users (those who rely on their voices for their livelihood) 6
• Presence of concomitant neck mass 6
• Respiratory distress or stridor 6
• Recent surgical procedures involving the head, neck, or chest 6
• Recent endotracheal intubation 6

Common Pitfalls to Avoid

• Do not proceed to surgery without an adequate trial of voice therapy (minimum 4-8 weeks with committed patient participation). 2
• Do not prescribe antibiotics for vocal polyps, as they are not effective for this condition. 2
• Do not treat empirically without direct laryngoscopic visualization to confirm the diagnosis and rule out malignancy. 7

Pediatric Population

In children, vocal polyps typically resolve over time during normal developmental processes. 1 Voice therapy should be considered the primary treatment, with surgery having a limited role and reserved only for severe cases refractory to conservative treatment. 1, 7, 2