The vocal cords are two folds that lie opposite each other in the larynx: muscle inside, covered by a thin, flexible lining. They meet at the front; when you breathe in, the gap between them opens, and when you speak they come together and the air from the lungs sets them vibrating to make the voice. Because that vibration repeats constantly through speech and song, using the voice for long periods, loudly or with poor technique puts the vocal cords under strain.
That strain can lead to benign growths on the surface of the vocal cords: nodules, polyps and cysts. Nodules are callus-like thickenings that usually form opposite each other in the middle of both vocal cords, and they are common in people who use their voice heavily, such as teachers, singers and speakers. These growths stop the vocal cords from vibrating evenly; the voice becomes hoarse and tires quickly, and if the strain continues the hoarseness can become long-lasting.
When surgery is needed
Hoarseness that has not improved within four weeks calls for an examination of the larynx with a laryngoscope, and sooner in smokers or when there is a sign such as a lump in the neck. For nodules, the first treatment is often voice therapy: learning with a voice therapist to use the voice without strain. Surgery is recommended for growths that cause symptoms and have not improved despite voice therapy and measures to protect the voice, or when the nature of a growth needs to be confirmed. If there are signs of reflux, its treatment is added to the plan.
What happens in the operation
Vocal cord microsurgery (microlaryngoscopy, MLS) is done under general anaesthesia, through the mouth, with no incision on the outside. A laryngoscope placed through the mouth brings the vocal cords into view, and Dr. Teker removes the growth under the microscope, preserving the vibrating surface of the vocal cord as far as possible. The parts of the larynx and pharynx around the vocal cords are examined in the same session. The operation takes about an hour; after a period of rest in hospital, most patients go home the same day, although this can vary with Dr. Teker’s assessment.
After the operation
The most important rule is voice rest for as long as Dr. Teker advises, often about a week. During this time, smoking, alcohol and anything that strains the throat are avoided. The voice is then brought back into use gradually, and healing of the vocal cords is assessed at check-ups. Help from a voice therapist to use the voice well, and treatment of reflux when it is present, help to lower the chance of the problem returning.
Protecting the voice
Surgery removes the growth; it does not remove the strain that caused it. The months after the operation are therefore also a chance to change how the voice is used. Drinking enough water, avoiding smoking and smoky places, keeping talk short or using a microphone rather than raising the voice in noise, resting the voice between long stretches of speaking, and taking vocal tiredness seriously all help to protect the vocal cords. If the voice becomes hoarse again, or a change does not settle within four weeks, another examination is advised.