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Benign vocal fold lesions: nodules, polyp, cyst, Reinke's oedema and contact ulcer
Each benign vocal fold lesion has a typical site, cause and treatment — bilateral nodules that respond to voice therapy, a one-sided polyp, an organic cyst, Reinke's oedema in smokers with a low voice, and a contact ulcer near the arytenoids linked to reflux.
Why it matters in the exam
Exam questions deal with site (where nodules sit, where a polyp sits, where a contact ulcer sits), cause (voice misuse, smoking, reflux), effect on the voice (Reinke's oedema lowers pitch; a lesion on the medial edge of the fold harms the voice more than one elsewhere) and treatment order (with nodules voice therapy comes before any surgery).
It is also important to tell organic from functional disorders: a cyst and a congenital laryngeal web are organic; nodules relate to voice use; and sulcus vocalis is characterised by a lack of tissue. The difference between laryngopharyngeal reflux (LPR) and ordinary reflux is asked as well: in LPR there is usually no heartburn. In young children nodules are seen more in boys, while among adults women are affected more.
Key points
- Nodules: bilateral, anterior-middle third, voice therapy first.
- Polyp: one-sided, middle of the membranous fold, usually surgery.
- Reinke's oedema: smoking, middle age, low voice.
- Contact ulcer: near the arytenoids, reflux; voice therapy and reflux treatment.
- Cyst, web and sulcus are organic.
Summary table
| Lesion | Site | Cause and typical group | Treatment |
|---|---|---|---|
| Nodules | Bilateral, where the front third of the folds meets the middle third; hourglass closure | Effortful, heavy voice use; young boys, adult women | Voice therapy and vocal hygiene first; surgery only if no improvement |
| Polyp | Usually one-sided, in the middle of the membranous fold | A single episode of strong vocal effort, sometimes a bleed | Usually surgery with voice therapy before and after |
| Cyst | One-sided, below the surface | Organic | Surgery; supporting voice therapy |
| Reinke's oedema | Bilateral, along the fold in Reinke's space | Smoking, voice use, reflux; middle-aged women | Stop smoking, surgery as needed; the voice is low |
| Contact ulcer or granuloma | Posterior, near the vocal process of the arytenoids | Reflux, hard glottal attack, intubation | Voice therapy and reflux treatment |
| Sulcus and web | Sulcus: lack of tissue along the fold; web: anterior and congenital | Organic | Surgery as needed; voice therapy to improve function |
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Sources
- Colton, Casper & Leonard, Understanding Voice Problems, 4th edition (2011) — Benign laryngeal lesions
- ASHA Practice Portal, 2024 — Voice Disorders
- Stemple, Roy & Klaben, Clinical Voice Pathology: Theory and Management, 6th edition (2018) — Pathologies of the laryngeal mechanism
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.