Vocal cord lesions are benign growths that develop on the vocal folds and interfere with normal voice production. The most common types are nodules, polyps, and cysts. These lesions cause persistent hoarseness, breathiness, voice breaks, and vocal fatigue. They are frequently seen in people who use their voice intensively and are highly treatable with voice therapy, surgery, or a combination of both.
Nodules are small, symmetrical, callous-like growths on both vocal cords at the point of maximum contact during vibration. They develop gradually from repeated vocal strain and are sometimes called "singer's nodules" or "teacher's nodules." They are the most common benign vocal cord lesion and often respond well to voice therapy alone.
Polyps are usually unilateral (occurring on one cord) and can develop suddenly after a single episode of vocal abuse, such as shouting at a sporting event. They are soft, fluid-filled or gelatinous growths that sit on the surface of the vocal cord. Polyps typically require surgical removal as they rarely resolve with voice therapy alone.
Cysts are enclosed, fluid-filled sacs that form within the vocal cord tissue rather than on its surface. They may be mucous retention cysts or epidermoid cysts and usually require surgical excision for definitive treatment.
The primary cause of vocal cord nodules is chronic vocal strain or misuse. Occupations with high vocal demands are at particular risk, including teachers, lecturers, singers, call centre workers, coaches, and barristers. Speaking loudly in noisy environments, persistent throat clearing, coughing, and poor vocal technique contribute to lesion development.
Polyps may develop after a single episode of intense vocal use. Smoking, dehydration, laryngopharyngeal reflux, and allergies can also predispose to vocal cord lesions by increasing inflammation and reducing lubrication of the vocal folds.
Diagnosis involves flexible nasendoscopy or videostroboscopy in the clinic. The ENT surgeon passes a thin camera through the nose to view the vocal cords directly, identifying the type, size, and location of the lesion. Stroboscopy provides a slow-motion view of vocal cord vibration, which helps distinguish between nodules, polyps, and cysts and guides treatment decisions.
Voice therapy with a speech pathologist is the first-line treatment for vocal cord nodules and early-stage lesions. Therapy focuses on reducing harmful vocal behaviours, improving vocal technique, and allowing the lesions to heal. Central Sydney ENT has an on-site speech pathologist who works closely with our surgeons.
When lesions do not respond to voice therapy, or for polyps and cysts that require removal, microlaryngoscopy is performed under general anaesthetic. Using a microscope and fine microsurgical instruments, the surgeon removes the lesion while carefully preserving the underlying vocal cord tissue. This is typically a day-surgery procedure.
Voice rest for seven to ten days after surgery is followed by a structured return to voice use under the guidance of a speech pathologist. Post-operative voice therapy reduces the risk of recurrence and optimises vocal recovery.
If you have persistent hoarseness or voice changes lasting more than three weeks, particularly if you use your voice professionally, you should be assessed by an ENT specialist. Early diagnosis and appropriate treatment can prevent progression and protect your voice long-term.
Central Sydney ENT has six FRACS-qualified ENT surgeons across seven Sydney locations in Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill, and Miranda.
Ask your GP for a referral to Central Sydney ENT, or call our reception team directly.