Vocal Cord Lesions

Normal Vocal Cord Function

Vocal cords, also called vocal folds, serve many functions in the human body. First, they play an important role in the production of a child’s voice. Secondly, they play an important role during swallowing and are one of the main ways that children are able to protect their airway while eating and drinking. When children swallow, closure of the vocal cords ensures that no food or liquid unnecessarily passes into the airway. Thirdly, they regulate pressure in the lungs and airway during exercise and coughing.

As a result of their many functions, problems with the vocal cords can lead to many different symptoms, including changes in the voice, difficulty with breathing, exercising or eating.

Vocal Cord Evaluation

If your child has persistent or worsening hoarseness, they need an evaluation. Depending on the problem, there are a wide variety of techniques available to evaluate your child’s voice, most commonly flexible laryngoscopy which can be performed in the clinic setting. During a flexible laryngoscopy a small fiberoptic scope is passed through your child’s nose and the larynx (voice box) can be seen on a video screen. Sometimes more precise voice measurements will be taken and videostroboscopy performed to further identify the cause of hoarseness. Voice evaluations are often performed in the presence of an ENT surgeon as well as a Speech Language Pathologist.

Vocal Cord Nodules

The most common cause of hoarseness in children is the presence of vocal cord nodules. Vocal cord nodules are lesions that prevent the vocal cords from closing completely. In children, almost all of these masses or lesions are benign (not cancer). The diagnosis of vocal cord nodules can be done by performing a flexible laryngoscopy.  Treatment is usually non-surgical, and options include watchful waiting, voice therapy with a speech language pathologist and/or medication to control gastropharyngeal reflux. Other masses on the vocal cords that can cause hoarseness include vocal cord polyps, vocal cord cysts, laryngeal papilloma and vocal cord granulomas.

Vocal Cord Papillomas (recurrent respiratory papillomas)

Laryngeal papillomas (also known as recurrent respiratory papillomatosis or “RRP”), are caused by the human papilloma virus (HPV).  The virus is most commonly acquired by the child from their mother at the time of birth. Papillomas typically require repeated surgical removal. For more information, visit https://rrpf.org/what-is-rrp/.

This photo shows recurrent respiratory papillomatosis (RRP) involving the larynx. The bulky lesions are seen obstructing the child's airway. This is often associated with hoarseness and noisy breathing, and can lead to respiratory distress.