NY Yankees Mariano Rivera Undergoes Vocal Cord Surgery

NY Yankees pitcher Mariano Rivera may have a fabulous right arm, but his voice was not exactly golden. He apparently had vocal cord polyps that resulted in a progressively raspy voice. Read the NY Post article.

On Dec 2, 2011, he underwent surgery to get them removed and if he now sticks to an appropriate voice therapy program, his voice should essentially revert completely back to normal! Watch the video to see what vocal cord surgery looks like.

There are MANY theories as to how vocal cord polyps as well as other similar vocal abnormalities like cysts and nodules form. However, one theory that seems to make the most sense to me deals with how the vocal cord heals after a phono-traumatic event like screaming or yelling... something I'm sure Mr. Rivera routinely performs during baseball games.

To differentiate among the various benign vocal cord masses, consider a cyst which is formed when 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 vocal cord lining. Vocal cord nodule for comparison's sake is just callous thickening of the vocal cord lining that occurs over time.

To use human skin as an analogy...

A vocal cord cyst is like a sebaceous cyst that commonly occurs under the skin of the face or neck (a pimple, but no opening to the surface).

A vocal cord polyp is like a blister that forms on the hand if you shovel dirt too much.

A vocal cord nodule is like a callous that forms after prolonged repetitive skin trauma (like callous on the hands after shoveling dirt for years).

Read more about vocal cord cysts, polyps, and nodules!

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.

Singer John Mayer Undergoes Vocal Cord Surgery

In September 2011, grammy-award winning singer John Mayer announced the cancellation of a number of concerts as well as an album due to the development of a vocal cord granuloma of his voicebox. Read a blog article about this.

Last week on Thurs, Oct 20, 2011, he underwent surgery to remove the granuloma and is now on strict voice rest for several weeks.

Though removal sounds like a great idea, vocal cord granulomas are notoriously difficult to eliminate completely as they have a high risk of recurrence. Strict voice rest as well as voice therapy helps as it eliminates the repetitive phonotrauma that promotes regrowth. Reflux control is also essential. However, it is not unusual that steroid injections to the granuloma site as well as even botox injection to partially and temporarily paralyze the vocal cord may need to be pursued for complete resolution.

Surgical removal of the granuloma may have looked something like this video...



Read more about vocal cord granulomas here.

Read a NY Magazine article about his surgery.