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Movable vocal polyp. Hoarseness and voice breaks. Smoker. Swollen throat. What needs to be done?

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ENT Specialist
Practicing since : 1991
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Hi I am AAAA XXXXXXX from India, inquiring for my father Mr. AAAA XXXXXXX who is diagnosed with movable vocal polyp along with other small nodules through video stroboscopy. He always used to shout even when speaking generally. He used to smoke 3-4 cigarettes a day.He had hoarseness and voice breaks for over a few months. Not much extreme yet noticeable. His ECG and blood reports are normal. Blood sugar level is just on level which can be taken as normal. Clear chest x-ray. No other complicacy. No blood with sputum ever.No such pain while swallowing. His throat region is swollen looks like thyroid. But he has no thyroid. He has no significant lump in throat region though one doctor said that he might have an enlarged thyroid gland.He is worried about whether thiere is any chance of malignancy. Can you tell us about his condition? What needs to be done? How urgently the operation needs to be done if needed. I am attaching the reports and prescriptions of him.
Posted Sat, 22 Sep 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 55 minutes later

Thank you for your query.

1. There are two prominent growths on the left vocal cord.

2. The white small growth on the anterior third of the left vocal cord may be a long standing Vocal Nodule, though it appears large for one. Other possibilities are a small mucus retention cyst or leukoplakia.

3. The large red growth on the middle third of the left vocal cord is a hemorrhagic polyp which appears mobile from the reports. The red appearance may also be due to trauma as the vocal cord vibrate and the polyp changes position rapidly.

4. I must emphasize that both lesions appear benign. However the best way forward is to plan a Microlaryngoscopy with an excision biopsy of both the growths which should be sent for Histo-Pathological Examination (HPE) to confirm the nature of these growths.

5. Excision of the growths will equate to af ull biopsy (as they are small) and give immediate relief.

6. A stand by laser or radio frequency equipment may help if there is excessive bleeding during the procedure.

7. Since he is obese, extra vigilance is required in the immediate post operative period, especially if he has obstructive sleep apnea. An elective tracheostomy does not seem necessary since most of his reports are normal. His operative treatment should be done only in a fully equipped major hospital /institute. It should be done as soon as possible. There is no dire emergency as his symptoms are since a year or so.

8. His Microlaryngosopy should not be a cause for worry and is perfectly indicated. Further treatment will depend upon his HPE report.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Movable vocal polyp. Hoarseness and voice breaks. Smoker. Swollen throat. What needs to be done? 2 days later
Hi, Thank you doctor for your detailed explanation. Currently we had his CT scan in contrast done. The CT scan strangely did only show the 0.6x0.7cm polyp in his left vocal chord. Everything is normal except that. My question is why did it not showed the white nodule? Is it normal for the CT scan to miss out on a nodule? Kindly see the reports again and do let me know. The scan was done after only 5 days of the stroboscopy. He had been in voice rest and was having two Disperzyme tablets daily for the past 7days. Kindly explain.
Answered by Dr. Sumit Bhatti 5 hours later

Thank you for writing back.

1. The CT with contrast picked up the larger polyp due to it's size and uptake of contrast as it seems vascular.

2. The smaller nodule is under the resolution of a CT Scan if the cuts are not taken less than 1mm on a multislice CT Scan machine. It also must have not taken up contrast due to its cystic, fibrosed or non vascular nature, hence it was missed on the CT report. It may have been hidden by the larger polyp resting on it. Sometimes it is visible on the scan images but not prominent. At times the CT scan software covers small areas up assuming them to be artifacts (a process known as partial volume averaging).

3. If it is visible on a follow up endoscopy or stroboscopy, it is proof that it is still there, irrespective of the scan report. If not visible anymore, it may have sheared off or resolved, which still leaves the larger to be treated. During the procedure, the surgeon can recheck under magnified vision.

4. MRI Scan of the larynx is the better imaging option which would have picked up both lesions. MRI imaging is better for soft tissue, Bone and fast moving blood is invisible on MRI. CT visualizes bone better than soft tissue. Hence both investigations compliment each other and hence are increasingly being done together. Cost is a constraint in India.

5. As a matter of argument, an experienced radiologist can even pick up vocal cord movement and nodules on a Neck / Laryngeal Ultrasound (USG).

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Movable vocal polyp. Hoarseness and voice breaks. Smoker. Swollen throat. What needs to be done? 10 hours later
Thank you doctor. So one final question: Is the white nodule any cause of worry or the red one. Although you mentioned that it seems benign. My father is very much worried about what the biopsy report will show.
Also after the operation how long will he be under complete voice rest? And does complete voice rest means not even humming to indicate a yes in reply?
Answered by Dr. Sumit Bhatti 1 hour later

Thank you for writing back.

1. The red larger polyp is more worrisome. However the final concern will be the HPE Report of both. Knowing an adverse report is better than the lesion spreading deeper silently. Early throat cancers can be treated very successfully now.

2. His voice will recover only after both are removed.

3. Voice rest will be for two to four weeks.

4. Speaking normally is less straining than whispering or humming.

Wishing him an uneventful surgery and a speedy recovery.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Above answer was peer-reviewed by
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