Vocal fold polyp is a benign hyperplastic lesion occurring in the superficial layer of the vocal folds, mainly at the edge of the junction of the anterior and middle 1/3 of the vocal folds on one or both sides, mostly translucent, white or light red swelling with smooth surface. The main manifestation is recurrent hoarseness, which is aggravated by excessive vocal use and can be temporarily reduced after rest, and the effect of oral medication is poor. The diagnosis can be confirmed by electronic laryngoscopy. The treatment is mainly surgical excision treatment, after surgery, patients with excessive use of voice, will make the vocal fold polyp re-generation, remember, not recurrence Oh.
I. Etiology.
1, excessive use of voice or improper use of voice, the most important reason. It is common in teachers, actors, singers and other long-term vocalists. When hoarseness occurs, the patient can not help but speak more forcefully and loudly, the sound temporarily increased, but the damage to the vocal cords aggravated, and then the voice will be more hoarse, into the face to form a vicious circle, making the vocal cord damage gradually aggravated, the vocal cord polyps also gradually increased. People who use their voice excessively have irritability, irritability, lack of patience and other personality characteristics, and are prone to overreaction, shouting and other bad vocal habits.
2, upper respiratory tract infection cold caused by acute and chronic laryngitis, excessive use of voice, it is more likely to occur vocal cord polyps.
Clinical manifestations: varying degrees of hoarseness, mainly related to the size and location of polyps. The larger the polyp is, the more hoarse the voice is; the symptoms are heavier when the polyp is located at the edge of the vocal folds and lighter when it is located on the surface of the vocal folds. Hoarseness occurs when the voice is used a lot, sometimes good and sometimes bad, intermittent hoarseness; it often appears in the high pitch, and is accompanied by delayed pronunciation, timbre changes, etc. Some patients may not see obvious voice changes in daily conversation, but when singing, there can be narrowing of the range, vocal restrictions and other more obvious performance. As the disease progresses, the hoarseness may become more severe, intermittent and persistent, and may also occur when the voice is lower.
The instability of the voice when speaking loudly prompts the patient to vocalize more excessively in the hope of improving the vocal effect, but excessive vocalization increases the damage to the vocal cords, which in turn aggravates the hoarseness. In addition, it is easy to be fatigued with the voice, feel the effort of speaking, dry and painful pharynx, and may also show the feeling of foreign body attachment in the pharynx. When the polyp is too large, it may cause dyspnea and laryngeal tinnitus, and if the base is very wide, it may cause loss of voice.
Second, examination.
Laryngoscopy (indirect laryngoscopy, fiberoptic laryngoscopy, electronic laryngoscopy, stroboscopy, etc.): diagnosis can be made through various laryngoscopic examinations combined with clinical symptoms. At present, electronic laryngoscopy is most commonly used.
Laryngoscopy reveals a smooth, soft, translucent neoplasm, white or pink, with a smooth surface at the junction of the anterior middle 1/3 of the vocal fold edge, which may be tipped or broad-based. Sometimes the free edge of the vocal folds on one or both sides shows a wide basal polyp-like lesion, and there are also polyp-like lesions with diffuse swelling throughout the vocal folds. The polyp is grayish or light red, occasionally purple-red, ranging in size from green beans to soybeans. Vocal fold polyps are generally unilateral and can occur on both sides at the same time. (Patients may ask why polyps mainly occur at the edge of the junction of the anterior and middle 1/3 of the vocal folds? That is because when pronouncing, in this position vocal fold vibration amplitude is the largest, the damage in this position is the most serious).
Third, treatment.
Including proper vocal fold rest, correction of bad vocal habits, medication and surgical therapy. Vocal fold polyps are mainly surgically removed at present.
1.General treatment
Vocal fold rest, vocal training is the main treatment means. In addition, smoking, alcohol and spicy and stimulating food should be restricted, avoid coffee, strong tea, etc.
2.Medication
Local physiotherapy and nebulized inhalation treatment can be given.
3.Surgical treatment
Vocal cord polyp excision is the main treatment method for vocal cord polyps at present. There are various surgical methods, depending on the size and location of the polyp. Smaller polyps can be removed under surface anesthesia by fiberoptic laryngoscope or electronic laryngoscope, but with the development of laryngeal microsurgery technology, the majority of patients with vocal fold polyps use general anesthesia under the support of laryngoscope microscope-assisted laser resection surgery and microscopic instrumentation microflap technology surgery.
4.Prognosis
If the patient is still exposed to risk factors such as excessive use of voice, inappropriate use of voice, smoking, etc. after improvement by treatment, vocal fold polyp can appear again. It is important to continue to use the voice scientifically and reasonably after surgery, and to conduct voice training if possible to change the bad vocal habits and prevent the most important means of vocal fold polyp recurrence.
Prevention
Vocal rest and vocal training can prevent the occurrence of the disease to a certain extent. At the same time, we should avoid smoking, drinking alcohol, eating spicy food and contact with other irritating pathogenic factors, and also pay attention to the prevention of colds and other upper respiratory tract infections to reduce the causes of vocal cord polyps.