Diagnosing Benign Vocal Cord Lesions

Like any part of the body, vocal cords can break down if used too much or improperly. At NYU Langone, doctors and therapists who specialize in treating vocal cord injuries understand that many people use their voices for a living and can offer individualized care focused on recovering your normal voice. 

Each time you use your voice, thin structures that stretch horizontally across the throat vibrate and collide in different patterns. These are the vocal cords, also called vocal folds. Overuse or abuse of the voice can lead to irritation as the vocal cords hit each other too frequently or with too much force. These irritated spots can then develop into benign lesions on the vocal cords, similar to the way a blister forms on skin if repeated contact is made with another surface. Noncancerous growths, scarring, and other areas of irritation are among the different types of benign vocal cord lesions.

A vocal cord lesion can develop because of a single event, such as a brief and isolated period of yelling or coughing, or from everyday speech habits that put stress on the vocal cords, like extended periods of talking loudly. Benign vocal cord lesions are not life threatening or cancerous, but, depending on their size and location, can affect the sound and quality of your voice. 

To diagnose a benign vocal cord lesion, NYU Langone voice specialists review your medical history, ask questions about when and how often you use your voice, and conduct a complete exam of your vocal cords and voice using various diagnostic techniques.

Voice Evaluation

A voice evaluation is a series of tests designed to determine the cause of vocal dysfunction. In a doctor’s office, a speech pathologist listens to the sound of your voice while making a brief recording. You may be asked to sing or read, so the pathologist can assess a variety of vocal qualities, including hoarseness, which can sound raspy or breathy and may indicate the presence of a benign vocal cord lesion. 

The recording is then run through several computer programs that are designed to analyze different aspects of your voice. The result is data that helps doctors identify the source of the hoarseness or other vocal dysfunction and is used as a baseline for comparison after treatment. 

A voice evaluation is almost always conducted in combination with laryngoscopy, a diagnostic technique that allows the doctor to take a close look at your vocal cords. 

Flexible Laryngoscopy

Flexible laryngoscopy helps your doctor to see your vocal cords. This exam lasts for about two minutes and can take place right in the doctor’s office. 

Your doctor applies a local anesthetic spray that numbs your nose and throat. Then he or she inserts a very thin, flexible endoscope—a device with a camera and light at the end—into a nostril and down to your vocal cords. A high-definition video camera embedded in the tip of the endoscope is controlled by your doctor and used to identify any lesions or other abnormalities. 

While the endoscope is in place and providing magnified images of the vocal cords, your doctor may ask you to speak or sing in order to see the vocal cords move and to assess any possible damage. Because the endoscope is inserted into the nose, you can use your voice normally during the exam.

Rigid Transoral Laryngoscopy

If a deviated septum or other nasal blockage might interfere with the use of a flexible endoscope, your doctor may decide to perform a rigid laryngoscopy. In this procedure, a topical numbing solution is sprayed into the throat, and a metal endoscope is inserted into the back of the mouth. A high-definition camera attached to the scope captures close-up images of your vocal cords and other parts of the throat. 

Laryngeal Stroboscopy

During a laryngoscopy, your doctor may also conduct another test called laryngeal stroboscopy in order to observe how often your vocal cords vibrate. Most human vocal cords vibrate between 120 and 240 times per second during regular conversation, which is a much faster rate than the human eye can see. 

Stroboscopy is a technique that uses fast flashes of light to illuminate the vocal cords. This strobe light is attached to an endoscope used during the laryngoscopy. The flashing light is first synchronized with the rate of vocal cord vibration, and then the timing of the flashes is slightly delayed. The result creates the illusion of your vocal cords moving in slow motion, allowing doctors to see even the subtlest structural features of your vocal cords.

In addition, a specially tuned microphone is placed against the outside of your throat during a stroboscopy, and the frequency of your vocal cord vibration is recorded for further analysis. 

Stroboscopy provides specialists at NYU Langone with comprehensive information about your voice, allowing doctors to make a precise diagnosis. 

Microlaryngoscopy

If your doctor sees structural damage to your vocal cords during a laryngoscopy or needs to examine a part of your throat that is difficult to reach or cannot fully be assessed during a flexible or rigid transoral laryngoscopy, a microlaryngoscopy may be recommended. In this exam, your doctor examines your vocal cords using a laryngoscope while you are under general anesthesia. This technique allows the doctor better access to the vocal cords without causing you discomfort. 

If necessary, your doctor can biopsy, or remove, a small tissue sample of the vocal cords during this procedure. Microlaryngoscopy is performed in a hospital and takes about 30 to 40 minutes. 

Voice specialists at NYU Langone are sensitive to the fact that your voice is part of what makes you unique, and that being able to express yourself is important. Whether you rely on your voice in order to do your job or want to eliminate hoarseness and discomfort, our doctors can identify convenient and safe treatment methods to help you get your voice back.