Vocal cord polyp resolves over time with reduced vocal use

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Small right vocal cord swelling, right vocal cord polyp, right vocal cord polyp/nodule, right vocal cord polyp standing out during stroboscopy, right vocal cord nodule with thick mucus, right vocal cord nodule with thick mucus on the left vocal cord, stroboscopy at high pitch, closed phase, stroboscopy at high pitch, open phase

 

James was age 27 when he first came to me for impairment of his singing voice. His singing became more effortful over 3 to 4 years. There was roughness in his upper vocal range. He recently switched from singing baritone, moving to a tenor.

.Small right vocal cord swelling

He has a very faint swelling on the right mid-vocal cord.

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2 years later:

 

He says,  “I went to my GP, about my morning hoarseness and possible acid reflux issues and he feels I may have an issue with nighttime reflux and has written me a prescription to address the problem.  However, he also has instructed me to inquire if Dr Thomas would have the inclination to ascertain if I might be a part of the 50% of the population that might have H pylori.  I suppose this would be accomplished through a biopsy of some kind.  I am hoping to compete in the MET auditions and would appreciate the peace of mind that comes with knowing my vocal folds are free of any pathology.” However, his effortful singing and speaking has worsened with short vocal endurance. His voice is worse in the morning. Also the more he uses it, the more it fades. He believes there is a roughness in his mid to upper range with breaks in his range. His primary care physician started him on Prilosec, which he has been taking with no change in his voice. 

At this time, his vocal cord swelling on the right side had enlarged further impairing his voice.

right vocal cord polypright vocal cord polyp/noduleright vocal cord polyp standing out during stroboscopy

On the photo during stroboscopy, with the vocal cords together, the swelling on the right side stands out very prominently, preventing his vocal cords from coming together.

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3 years later:

He has altered his vocal technique and reduced his vocal use. At a checkup, his voice is much improved.

right vocal cord nodule with thick mucusright vocal cord nodule with thick mucus on the left vocal cord

There is a thick stream of secretions on the right vocal cord on the left picture and on the left vocal cord in the right picture. The thickening on the medial margin on the right vocal cord is at the same site as his prior vocal polyp.There is a dilated capillary at the superior edge of the vocal cord nodule suggestive of previous vocal trauma.

stroboscopy at high pitch, closed phasestroboscopy at high pitch, open phase

The thickening on the right vocal cord is small enough that it does not impair closure of the vocal cords viewed here during stroboscopy in his upper vocal range. The left photo is during the closed phase were a very faint irregularity of the vocal cord margin is just barely perceivable. The right photo is taken during the open phase.

Apparently, either time, the change in his vocal technique, reduced vocal use or some combination of these 3, allowed the swelling on the right vocal cord to go down or improve. It is still visible as a flat thickened area, white in the photos during ABduction. He does have some thick secretions that tend to accumulate on the edge of the vocal cord. However his singing voice is relatively unimpaired.