ear, nose, and throat disorders
Vocal Cord Polyps, Nodules, and Granulomas
Treatment
Avoidance of cause For polyps, usually surgical removal Correction of the underlying voice abusecures most nodules and granulomas and prevents recurrence. Removal of the offending irritants (including treatment of any gastroesophageal reflux) allows healing and is necessary to prevent recurrence. Voice therapy with a speech therapist reduces the trauma to the vocal cords caused by improper singing or protracted loud speaking. Nodules usually regress with voice therapy alone. Granulomas that do not regress can be removed surgically but tend to recur. Traumatic polyps must be surgically removed to restore a normal voice. Other polypoid lesions, often bilateral, arising from tobacco abuse or hypothyroid states, should initially receive medical management. Cold-knife microsurgical excision during direct microlaryngoscopy is preferable to laser excision, which is more likely to cause collateral thermal injury if improperly applied. Papillomas are generally treated with laser or surgery. Human Papillomavirus (HPV) Vaccine can be preventive. Inmicrolaryngoscopy,an operating microscope is used to examine, biopsy, and operate on the larynx. Images can be recorded on video as well. The patient is anesthetized, and the airway is secured by high-pressure jet ventilation through the laryngoscope, endotracheal intubation, or, for an inadequate upper airway, tracheotomy. Because the microscope allows observation with magnification, tissue can be removed precisely and accurately, minimizing damage (possibly permanent) to the vocal mechanism. Laser surgery can be done through the optical system of the microscope to allow for precise cuts. Microlaryngoscopy is preferred for almost all laryngeal biopsies, for procedures involving benign tumors, and for many forms of phonosurgery. 