Vocal fold polyp is a benign condition of the vocal fold, which requires surgical excision under general anesthesia. We intend to look for any early premalignant changes among smokers with vocal polyp as it is a well-known carcinogen. Aim and objective: To study the (1) impact of smoking on the histopathology of vocal fold polyps and (2) serum IgE levels in patients with vocal cord polyps. Materials and methods: All patients above 18 years diagnosed with vocal polyp fitting into our inclusion criteria were included in the study. The study group was divided into group A—smokers with vocal polyp and group B—nonsmokers with vocal polyp. Serum IgE levels were assessed in all patients with vocal polyps. All patients underwent microlaryngoscopy and excision biopsy under general anesthesia. The surgical specimen was sent for histopathological examination. The pathologists were blinded to the smoking-related history. Results: In all, 70 patients diagnosed with vocal polyp were enrolled in the study with a smoker to nonsmoker ratio of 1:1. Voice abuse was seen in 85% of smokers and 74% of nonsmokers. There was an in increase in thickness of the basement membrane and fibrosis of vocal polyp in smokers on histopathological examination. Among the 70 patients we studied, dysplasia was seen in 10% of vocal polyps irrespective of smoking, which was statistically significant (p-value <0.001). Serum IgE was elevated in both smokers and nonsmokers (60%). Conclusion: Conflicting reports regarding the histopathological examination of vocal fold polyps suggest further multicentric studies. Histopathological evidence of dysplasia in statistically significant numbers in both groups suggests a mandatory early surgical excision.