Nodules are thickening of the middle of the vocal folds. They always occur in pairs-one on each vocal fold - and they are fairly symmetric, or similar in shape and size. Nodules are usually caused by excessive vocal demands, or improper speaking or singing techniques. It is commonly believed that when the nodules first begin to form, nodules are usually soft with a wide base. With time, they may become more firm, similar to calluses. Nodules usually form slowly over time. Nodules cause incomplete contact of the vocal folds, resulting in breathiness, decreased loudness, and vocal fatigue. The nodules can also cause irregular vocal fold vibration, resulting in hoarseness and pitch breaks.
Treatment for nodules is usually a course of voice therapy. Infrequently, surgery is required if the voice therapy does not provide adequate symptom relief for the patient.
The nodules prevent the vocal folds from closing completely during phonation
Sometimes nodules can become firm, as these are that protrude from the mid-portion of each vocal fold.
Often, nodules in the early stages of formation are soft, as these are that protrude from the mid-portion of each vocal fold.
Polyps can occur singly or in pairs. Usually, a polyp forms mid-way along the free margin of the vocal fold. Sometimes, a smaller lesion forms on the opposite vocal fold in reaction to the polyp, where the tissue gets irritated by the initial polyp hitting against it during each cycle of vibration. Unlike nodules which usually form slowly over time from repeated and prolonged irritation, a polyp can sometimes form as a result of an isolated traumatic occurrence, such as coughing violently or screaming at a sporting event.
Treatment for a polyp usually begins with voice therapy, often accompanied by voice rest, a significant (but temporary!) reduction in voice use. Sometimes, surgery is necessary in order to provide the patient with the best voice outcome.
The vocal fold on the left side of the picture has a firm-appearing polyp, which has caused irritation of the mucosa on the opposite vocal fold.
The polyp that protrudes from the vocal fold on the left has a blood supply, making it appear red.
The polyp prevents the vocal folds from closing during phonation.
Cysts are benign lesions that can occur singly or in pairs. A cyst is a collection of fluid in a sac-like structure. Cysts may be caused by a small gland in the vocal fold that does not drain well, and so it accumulates mucous. It is unknown whether vocal fold irritation or excessive voice use contributes to the formation of cysts.
Unlike nodules, cysts may not respond well to voice therapy alone. Depending upon the needs of the patient and the nature of the cyst, an abbreviated course of voice therapy may be recommended to determine whether surgery is necessary. For other types of cysts, surgical removal of the lesion is recommended, followed by a period of voice rest, a significant (but temporary!) reduction in voice use, and then voice therapy.
The vocal fold on the right side of the picture has a firm cyst.
The vocal fold on the left side of the picture has a cyst, causing the mucosal cover to bulge outward
The vocal fold on the left side of the picture has a large cyst which has caused irritation of the mucosa on the opposite vocal fold.
The vocal fold on the left side of the picture has a clearly-defined cyst which causes the vocal fold to bulge outwardly, impairing phonatory glottal closure and mucosal wave vibration.