Clinical Study on Laryngo-Microscopic Surgery for Vocal Nodules and Polyps

Vocal nodules and polyps are much more frequent in singers, public speakers, teachers and actors. Voice trauma and voice misuse, at times associated with mild inflammatory reaction, appear to be important in their etiology. It is generally agreed that vocal cord nodules and polyps are inflammatory in nature and they arise in the subepithelial layer of loose connective tissue of the vocal cord. Since the junction of anterior and middle thirds of the membranous cord and has the greatest amplitude of vibration.

This is the site of predilection for vocal cord nodules.

The author performed laryngomicrosurgery for 50 cases of vocal nodules and polyps at Ewha Womans University Hospital during the period of 3 years.

The results obtained were as follows:

1) Surgical excision is not necessarily the best approach because vocal nodules in the early stages will resolve with the simplest voice therapy.

2) In children, surgery is rarely indicated because most nodules in children regress during adolescence.

3) For patients who use their voices professionally, voice therapy is indicated for three months.

4) If after three month of conservative treatment the cord lesion does not improve and the patient it still dissatisfied with his voice, laryngomicrosurgery can then be considered.

5) The small cuffed endotracheal tube in the interarytenoid space helps to keep the cords immobile and in an abducted position.

6) Removal of the nodule should be started by gentle retraction posteriorly and as soon as a tear appears anterior to the nodule.

7) On occasion it is preferable to start the dissection with a siccle knife while the nodule is held on the stretch.

8) Voice rest should be maintained for a week following which the free edges of the cords are usually healed.