Definition & Overview

Vocal voice surgery is a procedure of treating abnormalities in the vocal cords or vocal folds such as the growth of nodules, polyps, and cysts that are quite prevalent among singers and those whose jobs require raised voices, screaming, or talking for long periods.

The vocal cords have delicate linings on the outside and are composed of mucous membranes that form folds of tissues stretching across the larynx. The folds modulate airflow from the lungs, vibrating rapidly when the person speaks or sings. When abused, such as due to smoking or singing incorrectly, the linings of the folds can get injured or develop abnormal growths.

Typically, people with injured or diseased vocal cords are advised to undergo voice rest and not to tax the affected part. Unresolved cases, however, may merit surgical treatment.

Who Should Undergo and Expected Results

Vocal voice surgery can be recommended to:

  • People diagnosed with benign or noncancerous lesions in the vocal cords. These growths are often referred to as singer’s nodes or screamer’s nodes. Under the microscope, these nodules are similar to calluses and are usually located in the middle part of both folds. In some cases, complete voice rest for several months is all that it takes to treat this condition. However, for persistent nodes or calluses, the patient can be advised to undergo surgery to remove the nodes permanently.

  • Some people who experience hoarseness of voice caused by vocal cord polyp. Polyps occur in different shapes and sizes, typically affecting only one fold. Surgery is one suitable treatment option for this condition. In some cases, a reactive voice lesion may develop opposite the polyp, as a result of trauma caused by the abnormal growth.

  • Patients diagnosed with cysts in the vocal cords. These cysts are typically composed of a solid mass of tissue within a membrane sac, located on the surface or within the folds. This condition can significantly change the pitch and quality of voice. Patients are typically advised to undergo vocal voice surgery before they lose the ability to speak.

Vocal voice surgery is considered a safe procedure with high success rate. Most patients, especially singers, are able to recover the quality of their voices following surgery.

How is the Procedure Performed?

There are several techniques that the surgeon can apply to perform this type of procedure. These are:

  • Micro-direct laryngoscopy with mass excision – This is performed on patients with vocal cord polyps or nodules. For this procedure, the patient is administered with general anaesthesia before a small tube and specialised microscopic tools are inserted through the mouth. Using imaging technology, the lesion or nodule is excised. The surgeon then withdraws the specialised tool and leaves the wound open to reduce the risk of scarring, which is known to cause raspy voice quality. Patients are required not to talk until the wound has completely healed since this could cause further injury to the vocal cords.

  • Micro-direct laryngoscopy with micro-flap mass excision – This is another technique that bears similarity to the first one but is performed to remove abnormal growths under the lining of the vocal cords. For this procedure, an incision is made on the vocal cord itself to carefully remove the polyp or nodule. The incision is also left open and no suture is applied.

  • PDL/KTP lasers - This is performed on an outpatient basis without the use of anaesthesia. For this procedure, an endoscopic scope is inserted through the nose and threaded to the vocal cords. The surgeon then fires laser pulses at the abnormal growth masses to melt them away.

Patients are also urged to undergo voice rehabilitation and therapy programs following this procedure. Singing, screaming, and talking for long periods should be avoided until the surgical site has completely healed.

Possible Risks and Complications

Undergoing surgery carries the risk of developing adverse reactions to anaesthesia as well as bleeding and infection at the surgical site. Other risks include:

  • Altered taste perception
  • Numbness of the tongue
  • Injury to the oral cavity and the pharynx

In some cases, patients may never recover their original voice quality and some may even have permanent raspy or hoarse voice. Formation of scar in the vocal cords is also a possibility.


  • Blake Simpson, Clark Rosen, Hans Von Leden, Robert H. Ossoff (2008) Operative Techniques in Laryngology
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