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Vocal Cord Polyps, Nodules, and Granulomas

by Clarence T. Sasaki, MD

Vocal cord nodules, polyps, and granulomas are noncancerous (benign) growths that cause hoarseness and a breathy voice.

Vocal cord polyps are often the result of an acute injury (such as from shouting at a football game) and typically occur on only one vocal cord. Polyps may have several other causes, including gastroesophageal reflux, or chronic inhalation of irritants (such as industrial fumes or cigarette smoke). Polyps tend to be larger and bulge out more than nodules. Polyps are common among adults.

Vocal cord nodules occur on both vocal cords and result mainly from chronic abuse of the voice (habitual yelling, singing, or shouting or using an unnaturally low frequency). Nodules can occur in children.

Vocal cord granulomas are often the result of vocal cord injury due to uncontrolled gastroesophageal reflux (see Gastroesophageal Reflux (GERD)) or damage during endotracheal intubation (insertion of a plastic breathing tube through the mouth into the windpipe [trachea]). Granulomas are common among adults.

Vocal Cord Problems

When relaxed, the vocal cords normally form a V-shaped opening that allows air to pass freely through to the trachea. The cords open when air is drawn into the lungs (inspiration) and close during swallowing or speech.

Holding a mirror in the back of a person's mouth, a specially trained doctor can often see the vocal cords and check for problems, such as contact ulcers, polyps, nodules, granulomas (not shown), paralysis, and cancer. All of these problems affect the voice. Paralysis may affect one (one-sided) or both vocal cords (two-sided—not shown).


Symptoms include chronic hoarseness and a breathy voice, which tend to develop over days to weeks.


A doctor makes the diagnosis by examining the vocal cords with a mirror or a thin, flexible viewing tube (laryngoscopy). Sometimes the doctor removes a small piece of tissue for examination under a microscope (biopsy) to make sure the growth is not cancerous (malignant).


Treatment is to avoid whatever is irritating the voice box (larynx) and rest the voice. If abuse of the voice is the cause, voice therapy conducted by a speech therapist may be needed to teach the person how to speak or sing without straining the vocal cords. Most nodules and granulomas go away with this treatment. Granulomas that do not go away can be removed surgically but tend to come back.

Most polyps must be surgically removed to restore the person's normal voice.

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