Therapy
If the nodules are only small and have only recently caused complaints such as hoarseness and a rough voice, your ENT specialist will first advise you to take care of your voice. In some professions, such as that of a teacher, there is a lot of talking that you cannot get past. In this case the specialist will give you a certificate.
In the case of so-called screaming children, further diagnostic measures may be appropriate to find out the cause of the excessive screaming. Pediatricians, psychologists and neurologists can be typical points of contact for the diagnosis of crying children. If there is no improvement even after voice protection, the doctor will discuss the possibility of a possible change of profession with you and explain the benefits of long-term voice protection.
In the case of larger, hard nodules that block the voice almost completely, there is the option of surgical removal. This is a minor procedure that usually does not lead to more serious complications. Nevertheless, a longer period of vocal protection must be planned after the operation.
In the acute phase the voice should be spared as much as possible. Vocal exercises should still be used to avoid further vocal fold overload. The exercises should also be repeated daily.
The patient can start with an exercise that strengthens the diaphragm, since the diaphragm is important for a strong voice and can thus relieve the vocal cords. The exercise is done in a straight sitting position. The sounds “Psst” and “Ksch” are spoken alternately.
During the exercise, attention should be paid to good body tension and posture. Another vocal exercise is for example the so-called “chewing hum”. Here the patient imitates a chewing movement with open mouth and lets the sounds “mmmh” and “mjam” sound.
Singing “nnn” and “mmm” in a melody (for example a scale) also trains the vocal chords. Here it should be made sure that no tones that are too low or too high are sung, since this again puts too much strain on the vocal chords. There are many other exercises that should be discussed individually with a speech therapist.
Speech therapy (speech and language therapy) is an important means of treating the vocal fold nodules and symptoms. Patients should definitely take advantage of professional therapy. Especially if – as is often the case – a profession is practiced where a lot is spoken (for example, teacher).
In the speech therapy sessions, breathing exercises and finding the right voice pitch are trained with the patients. These exercises can then be performed daily by the patient at home. If speech therapy does not show any success after a few weeks, however, surgical removal of the nodules should be considered.
Surgical removal of the vocal cord nodules is not necessary in most cases. Thus, the nodules usually recede by themselves after the vocal cords have been spared, and the disturbing symptoms diminish. Nevertheless, it is possible that only an operation to remove the nodules will bring improvement.
This is especially the case if the vocal cords are not spared after initial nodules have formed. In these cases it can happen that hard nodules form on the already formed, so-called soft nodules. These can then only be removed with an operation.
Specialists in the field of these operations are specialists in ear, nose and throat medicine. The operation itself is a minor procedure and is usually not associated with serious complications.However, since every operation involves a certain residual risk, it is recommended to spare the voice directly after nodulation to avoid the operation. In addition it applies to mention that despite an accomplished operation, if the vocal cords are further overloaded, further nodules can develop. Therefore, at the beginning of the disease, a speech therapy with a speech therapist is preferable to surgery.
