About Vocal Cord Polyps
A vocal cord polyp is a benign (non-cancerous), usually gelatinous mass that typically occurs just below the surface membrane of the vocal cord. In contrast to polyps in other parts of the body (eg polyps in the colon), there is no chance of degeneration of a genuine vocal cord polyp into cancer. Vocal cord polyps are considered “phonotraumatic” lesions because they often result from significant voice use or voice abuse. They typically occur along the free edge of the vocal cords, usually at the point of maximal vibration amplitude (eg the central zone), where the physical forces are the greatest during speaking or singing.
Vocal cord polyps can be quite varied in their presentation. In general, a vocal cord polyp can be classified as either
hemorrhagic (blood filled) or non-hemorrhagic (which some further divide into translucent or fibrotic [opaque, firmer] types). These likely represent evolving stages of the same pathology over time, with the hemorrhagic polyp being the acute form that progresses to a non-hemorrhagic form over time.
While a polyp classically involves just one vocal cord, polyps can sometimes involve both vocal cords. This is not to be confused with Reinke’s edema (“smoker’s polyps”), which are special types of vocal cord polyps that usually occur on both vocal cords and are, as the name implies, related to smoking.
Sometimes there can also be a “reactive nodule” along the opposite vocal cord at the point where the polyp collides with it.
Like most other structural lesions of the vocal cord, a vocal cord polyp produces a disordered voice by affecting how the vocal cords close and / or vibrate during speaking and / or singing. The degree of vocal impairment often correlates with the size of the lesion, but not always; in some cases, even a small vocal cord polyp can result in a very disordered voice if it is located in the right (wrong) location, much as a pebble in the bottom of one’s shoe can feel like a boulder.
Polyp Type
Office View
Operating Room View
Hemorrhagic


Non-Hemorrhagic, Translucent


Non-Hemorrhagic, Fibrotic


Office View
Hemorrhagic

Non-Hemorrhagic, Translucent

Non-Hemorrhagic, Fibrotic

Operating Room View
Hemorrhagic

Non-Hemorrhagic, Translucent

Non-Hemorrhagic, Fibrotic


Right vocal cord polyp with small reactive nodule on left vocal cord (yellow arrow), as seen in both the office and the operating room.
Vocal Cord Polyp Surgery
While voice therapy, voice rest, and/or sometimes observation alone can be management strategies for a vocal cord polyp, microlaryngoscopy with phonosurgical excision is currently the standard treatment for restoration of voice. The timing of surgery may depend on a number of factors, including how important it is for a patient to have his or her voice restored. For example, a professional opera singer may have little tolerance for trials of non-surgical management, whereas a causal voice user with minimal occupational and social vocal demands may elect for non-operative treatment initially.
Surgical excision of a vocal cord polyp is most precisely performed under general anesthesia using an operating microscope and a microflap technique, during which a small flap of tissue containing the polyp is carefully raised. Then, the typically gelatinous polyp contents are removed from the delicate surface membrane (epithelium) of the vocal cord without tearing or poking a hole in it. (In otherwise healthy vocal cords, this surface membrane is typically 10 – 15 cell layers thick and translucent, similar to plastic wrap.) While redundant epithelium must usually be trimmed after removal of the polyp (which has stretched it), the goal is to preserve the surface membrane as much as possible so as to minimize the wound gap that has to heal post-operatively. This is most achievable in polyps that are sessile (have a broad attachment).
For polyps that are pedunculated (narrow attachment), it may not be possible to preserve much (or any) of the overlying epithelium. Irrespective of its attachment shape, a key step in phonomicrosurgery for any type of vocal cord polyp is to accurately define the deep interface of the polyp and to isolate it from the healthy vibratory tissue next to it (superficial lamina propria (SLP)), which should be maximally preserved. Failure to do so may result in an irreversibly stiffened vocal cord and permanent hoarseness.

Right (left side of image) vocal fold hemorrhagic polyp, as viewed in the office.

Same hemorrhagic polyp, as viewed in the operating room, with 4 millimeter probe next to lesion.

After the hemorrhagic portion of polyp has been removed, a microflap with residual polypoid material remains. Because of this, the translucent nature of normal vocal fold epithelium is not obvious (compared to image E).

Removal of the polypoid contents from the microflap with 1 millimeter cup forceps. The microflap is extremely delicate and can be easily torn or punctured.

After the microflap has been thinned of residual polypoid material, the translucent character of healthy vocal fold epithelium is now apparent (compare to image C). Microscissors are being used to trim the redundant edge of the microflap.

The incision in the vocal fold is barely visible after re-draping of the trimmed microflap.
While voice therapy, voice rest, and/or sometimes observation alone can be management strategies for a vocal cord polyp, microlaryngoscopy with phonosurgical excision is currently the standard treatment for restoration of voice. The timing of surgery may depend on a number of factors, including how important it is for a patient to have his or her voice restored. For example, a professional opera singer may have little tolerance for trials of non-surgical management, whereas a causal voice user with minimal occupational and social vocal demands may elect for non-operative treatment initially.
Surgical excision of a vocal cord polyp is most precisely performed under general anesthesia using an operating microscope and a microflap technique, during which a small flap of tissue containing the polyp is carefully raised. Then, the typically gelatinous polyp contents are removed from the delicate surface membrane (epithelium) of the vocal cord without tearing or poking a hole in it. (In otherwise healthy vocal cords, this surface membrane is typically 10 – 15 cell layers thick and translucent, similar to plastic wrap.) While redundant epithelium must usually be trimmed after removal of the polyp (which has stretched it), the goal is to preserve the surface membrane as much as possible so as to minimize the wound gap that has to heal post-operatively. This is most achievable in polyps that are sessile (have a broad attachment).
For polyps that are pedunculated (narrow attachment), it may not be possible to preserve much (or any) of the overlying epithelium. Irrespective of its attachment shape, a key step in phonomicrosurgery for any type of vocal cord polyp is to accurately define the deep interface of the polyp and to isolate it from the healthy vibratory tissue next to it (superficial lamina propria (SLP)), which should be maximally preserved. Failure to do so may result in an irreversibly stiffened vocal cord and permanent hoarseness.
Before Vocal Cord Polyp Surgery
After Vocal Cord Polyp Surgery
Examples of Vocal Cord Polyps – Before and After Surgical Treatment

Before

After
A right (left side of image) vocal cord hemorrhagic polyp before and after (2 months) microlaryngeal surgical exicision. (There are excess secretions along the in the before picture, causing the vocal cord to appear focally white in the collision zone with the polyp.)

Before

After
A pedunculated left (right side of image) vocal cord hemorrhagic polyp before and after (2 months) microlaryngeal surgical excision.