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Phonotrauma (Benign Vocal Fold Lesions)

What is phonotrauma?

Your vocal cords vibrate very quickly, with collisions of one vocal cord against the other at frequencies reaching hundreds of times per second. If the voice is used too much or improperly, these collisions can lead to the development of lesions on the vocal cords that affect how they come together and/or vibrate, a condition called phonotrauma. People who use their voice a lot are most susceptible to phonotrauma, and this group includes speaking-voice users, such as teachers, salespeople, broadcasters, businesspeople, lawyers and health professionals, as well as performing-voice users like singers or actors.

Phonotrauma can manifest a number of different ways:

  • Vocal nodules (callouses) are superficial lesions on the lining of the vocal cords and usually occur in the middle of both vocal folds.

  • A vocal cord polyp (blister) usually occurs on one vocal cord. It can be either soft or firm, and it is sometimes red when it it develops following a sudden hemorrhage.

  • A vocal cord cyst is deeper in the vocal fold, under the superficial lining. Many are believed to start following phonotrauma, but some may be there from birth and grow very slowly with time.

  • Varices and ectasias are dilated or abnormal blood vessels and other vascular malformations under the surface of the vocal cord that can bleed and cause focal fold stiffness.

  • Vocal cord sulcus, or an indentation along the inner edge of the vocal cord, is caused by vocal cord scarring and can lead to reduction in vocal cord vibration.

Phonotrauma Treatment

Treatment of benign phonotraumatic vocal cord lesions depends on a number of factors, including the nature of the lesion, your particular voice needs and your degree of voice difficulty. Your treatment team will develop a personalized treatment plan.

Voice therapy with a speech-language pathologist can improve voice in many patients with phonotrauma, and can even cure some types of vocal cord lesions. Using appropriate vocal techniques can help you manage your vocal symptoms even if the lesion still remains and prevent problems from reoccurring or worsening with time. Voice therapy is often recommended either alone or in combination with other treatments.

Phonosurgery (surgery to improve the voice) is performed when voice complaints persist and a lesion on the vocal cords does not completely respond to voice therapy. The goal of phonosurgery is to remove the lesion and preserve adjacent areas of normal vocal cord tissue that are crucial for preserved vocal cord vibration. Preserving this normal tissue next to the lesion is a critically important step in achieving ideal voice outcomes, and special techniques by surgeons who specialize in vocal cord surgery can help to make sure that vocal cord function is optimized. Even when surgery is needed, voice therapy is often still advised to ensure proper voice use during the healing process.

In some circumstances, a phonotraumatic lesion on the vocal cords may be well-suited for in-office treatments, including vocal fold injections or KTP laser treatments.

Reviewed by Lee Akst, M.D., from the Department of Otolaryngology-Head and Neck Surgery.

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