Laryngeal polyps, benign growths within the voice box (larynx), are an overlooked cause of persistent respiratory symptoms, including a troublesome cough. The presence of this abnormal tissue interferes with the sensitive mechanics of the airway, often leading to a chronic, irritating cough reflex. Understanding these growths and the methods for their removal is the first step toward finding relief.
What Are Laryngeal Polyps?
A laryngeal polyp is a non-cancerous, fluid-filled growth that develops on the surface of the vocal folds. These folds are the two bands of muscle tissue within the larynx responsible for producing sound. Polyps often appear as a blister-like or red mass, typically found on only one side of the vocal cord. They can be broad-based, covering a large surface area, or attached by a narrow stalk, making them highly mobile.
The most common reason for their formation is phonotrauma, which is physical stress or injury to the vocal cord tissue. This injury results from vocal misuse, such as yelling, excessive speaking, or an intense traumatic event like a severe coughing fit. Other contributing factors that cause chronic irritation include long-term exposure to inhaled irritants like tobacco smoke, untreated gastroesophageal reflux disease (GERD), and hormonal imbalances like hypothyroidism.
How Polyps Trigger the Cough Reflex
The chronic cough associated with laryngeal polyps is an irritative dry cough triggered by the physical presence of the growth. The polyp protrudes from the vocal cord surface, acting as a mechanical obstruction that disrupts the smooth flow of air and the precise closure of the vocal folds. This constant physical interference creates a foreign body sensation in the throat, which powerfully triggers the cough reflex.
The laryngeal mucosa lining the vocal cords is extremely sensitive and extensively innervated by the superior laryngeal nerve. When the polyp repeatedly irritates this delicate lining, the nerve sends a signal to the brainstem’s cough center. The brainstem interprets this signal as a need to forcibly expel a foreign object, resulting in a persistent, involuntary cough. In rare cases, a large polyp can be drawn into the subglottic area during inhalation, potentially obstructing the airway and inducing a serious coughing fit and difficulty breathing.
Identifying and Diagnosing Laryngeal Polyps
The persistent cough is one of several symptoms signaling the presence of a laryngeal polyp. Patients often experience significant voice changes, most commonly persistent hoarseness or a rough, breathy voice quality. The bulk of the polyp prevents the vocal folds from vibrating efficiently or closing fully, which leads to vocal fatigue and a reduced vocal range.
Many individuals also report a frequent need to clear their throat or a constant feeling of a lump stuck in the throat, known as globus sensation. When a specialist suspects a polyp, diagnosis is confirmed through a procedure called laryngoscopy. During this examination, a thin, flexible tube equipped with a camera is inserted through the nose or mouth to visually inspect the vocal cords. A more detailed examination, videostroboscopy, uses a strobe light to capture vocal cord movement in slow motion, allowing the physician to clearly see how the polyp affects vocal fold vibration and closure.
Treatment Options and Symptom Resolution
Treatment focuses on removing the growth and correcting the behaviors that caused the initial injury. For smaller polyps, non-surgical management is the first step, involving intense voice therapy with a speech-language pathologist. This therapy teaches healthy vocal techniques to reduce strain, which can sometimes allow the polyp to shrink or resolve. Treating underlying causes like acid reflux or allergies with medication is also necessary to reduce throat irritation and inflammation.
If the polyp is large, causes significant symptoms, or does not respond to voice therapy, surgical removal is necessary. This procedure, called microlaryngoscopy with excision, is performed under general anesthesia using a microscope to precisely remove the polyp while preserving healthy tissue. Following surgery, patients must adhere to strict voice rest, followed by continued voice therapy to ensure proper healing and voice retraining. Once the physical obstruction is removed, the source of laryngeal irritation is gone, and the chronic cough almost always resolves completely.