November 03, 2011

Singer Keith Urban to Undergo Vocal Cord Surgery

The year 2011 so far seems to be the year for vocal cord surgery in singers... John Mayer, than Adele, and now Keith Urban.

On Nov 3, 2011, it was announced that country singer Keith Urban will be undergoing vocal cord surgery to remove a polyp from his vocal cords forcing him to cancel/postpone upcoming concerts. Read ABC News report here.

A vocal cord polyp would cause a mild rasp in the voice that is worse in the upper pitch range and soft voice. Onset delays and pitch breaks are common.

There are several theories as to why a vocal cord polyp may form on the vocal cord in the first place. My personal favorite theory is as follows. At some point, an acute traumatic event to the vocal cord occurred stemming from a yell, cough, excessive singing, or laryngitis. Depending on what happens next determines whether a polyp or cyst develops. With a cyst, the mucosal vocal cord lining breaks down and during the healing process a cyst develops due to entrapped cells meant for creating lining. A polyp, however, is in essence a blistering of the lining. Vocal cord nodule for comparison's sake is just callous thickening of the vocal cord lining.

Traditional standard of care management of a vocal cord polyp starts with voice therapy and avoidance of any activities leading to voice abuse (screaming, yelling, etc). The main reason is that with voice therapy alone, it is not uncommon that the polyp may resolve to point where the vocal quality becomes acceptable and stable. However, more often, only mild improvement occurs with persistence of hoarseness. At this point, surgical excision is recommended. Watch video.

With a polyp, it is simply grabbed and removed at its base. Typically no sutures are used to close the incision after excision, mainly because sutures tend to promote scar formation that can adversely affect the voice. After surgery, STRICT voice rest is mandatory to allow the body to heal the surgical wound site. After about 1-2 weeks, the patient is allowed to start talking in small increments under the guidance of a voice therapist until complete healing has occurred in about 4 weeks. However, the vocal cord lining is "brand new" and careful voice use is recommended for at least 6 months (absolutely no screaming, yelling, or excessive voice use) which risks mucosal tearing and recurrence. Eventually, the patient may use their voice without restriction. Both for 1 week before and up to 3 months after surgery, reflux medications are recommended for reflux prophylaxis. Why? Because if there's ANY acid that washes over the surgical site from a reflux event, healing will not occur properly (imagine putting some acid drops into the eye after eye surgery). As a reminder, though vocal cord polyps can be removed with surgical excision, they can recur if underlying abusive voice behavior that led to the initial formation is not addressed.

Read more about vocal cord polyps here.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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