Vocal fold nodules are thickenings at the edge of the vocal folds. They are also called crying nodules, singing nodules or vocal cord nodules. The thickened elevations are often mirror-like and comparable to the development of callus on normal skin. As a result of vocal fold nodules, the vibration process on the vocal fold mucosa is disturbed. The normal closure of the vocal folds is also impaired.
What are vocal fold nodules?
Vocal fold nodules are one of the so-called organic voice disorders. They form on the vocal folds and appear in the form of double-sided nodule formations. When the vocal folds are no longer able to vibrate freely as a result of mechanical overload, corresponding nodules can form. In this case, initially soft vocal nodules develop into hard thickenings after continued stress. These form at the points that are under the highest pressure when the voice is used and are initially covered by mucous threads. Vocal fold nodules are an extreme form of so-called hyperfunctional dysphonia. As a rule, they lead to hoarseness and a rough voice with the constant feeling of having to clear one’s throat. Basically, vocal fold nodules occur exclusively in women. Men, on the other hand, can only suffer from the so-called singer’s nodules, which mainly affect tenors.
Causes
Vocal fold nodules are the result of long-term overuse of the voice. Responsible for this overuse is sometimes a non-physiological vocal technique. However, a number of other causes are possible for the organic changes that show up on the vocal folds. In most cases, a vocal overload or an incorrect strain on the voice is the underlying cause for the formation of vocal fold nodules. This occurs, for example, in people who regularly speak in noise. Due to incorrect vocal technique, speaking is done with an unusually high physical effort and pressure. In singers, vocal fold nodules occur especially when singing frequently in an incorrect pitch and the voice is overstrained. In this case, the vocal fold nodules are called singer’s nodules. In children, vocal fold nodules very often develop as a result of loud and frequent speaking. Here, the thickenings on the vocal cords are called crying nodules. In addition, people who are hard of hearing are also often affected by vocal fold nodules because they often speak too loudly and put the wrong strain on their voice.
Symptoms, complaints, and signs
The typical symptoms of vocal fold nodules can be many-sided and vary depending on the severity and location of the thickening on the vocal cords. In the majority of cases, vocal fold nodules are manifested by a hoarse and rough voice. Speaking is difficult, and in some cases the voice fails. Sometimes a foreign body sensation is felt during speech. In addition, many affected persons have the urge to clear their throat frequently. In most cases, however, this does not help to reduce the discomfort in the vocal cords and the urge to clear the throat recurs. The voice may become increasingly less strained as a result of the vocal fold nodules. The changes on the vocal folds form at their edges. The vocal fold nodules often occur in the transition area from the front to the middle third of the vocal folds. A slight edema forms here when the voice is overloaded, but it disappears when the voice is rested. If the strain continues, the edema increases. Soft nodules develop, which turn into hard vocal fold nodules if the strain continues. If the nodules are particularly large, a so-called hourglass glottis develops.
Diagnosis and course of the disease
A number of examination methods and measures are available for the reliable diagnosis of vocal fold nodules, the selection of which is decided by the attending physician after examination of the individual case. In principle, it is advisable to consult a specialist in otorhinolaryngology if the presence of vocal fold nodules is suspected. If possible, a doctor of phoniatrics who specializes in voice disorders should be consulted. In the course of a reflection of the larynx, it is possible for the doctor to examine the vocal organ of the affected person in more detail.This makes it possible to detect organic changes in the vocal folds, for example in the form of nodule formation. In addition, the doctor recognizes the type of nodules present during laryngoscopy. The presence of soft or hard nodules allows conclusions to be drawn about the extent of the vocal fold nodules.
Complications
The foreign body sensation typical of vocal fold nodules causes affected individuals to clear their throats frequently, placing additional strain on the vocal cords. As the disease progresses, the voice can be subjected to less and less strain, and inflammation or edema occasionally develops. If the strain is not reduced, the edema increases – further nodules develop and the complaints increase. If the nodules are particularly pronounced, a so-called hourglass glottis can develop, a pathological change in the vocal cords. If this remains untreated, it may lead to complete loss of voice. There are usually no complications associated with the treatment of vocal fold nodules. Usually, speech therapy is ordered for the voice, which may cause further problems if misdiagnosed. If painkillers or anti-inflammatory drugs are prescribed due to severe discomfort, problems can sometimes arise. For example, there may be side effects and interactions that cannot always be foreseen before the drug is taken. Typical complaints include gastrointestinal problems, cardiovascular complaints or headaches and aching limbs. Patients suffering from another disease or already taking another medication are particularly at risk for any interactions.
When should you see a doctor?
As a rule, a doctor should be consulted in any case of a vocal fold nodule. Only an early visit to a doctor with subsequent treatment can prevent further complications or discomfort. There is no self-healing and the symptoms will worsen if the vocal fold nodule is left untreated. A doctor should be consulted for this condition when the affected person can no longer speak easily. Speaking itself is usually difficult for the patient, with permanent hoarseness also occurring. In many cases, sufferers have to constantly clear their throat, which further damages the vocal cords. If these complaints occur, a doctor must be consulted immediately so that the vocal cords are not further damaged by the vocal fold nodules. Usually, vocal fold nodules can be treated relatively well by an otolaryngologist or by a general practitioner.
Treatment and therapy
Treatment of vocal fold nodules depends on the consistency of the nodules present. For soft vocal fold nodules, the physician usually prescribes vocal rest. In the case of speaking occupations, this is often only possible by means of a sick leave. In addition, a logopedic voice therapy can be prescribed to reduce the incorrect voice technique. Since this is often associated with a longer absence from work, soft vocal fold nodules are increasingly removed surgically. Vocal rest is also recommended for hard nodules. In most cases, hard vocal fold nodules are removed by surgery. The patient then undergoes logopedic voice training. This involves training the patient’s perception of his or her own voice and breathing, and improving his or her hearing. The therapy is performed by trained voice therapists, such as speech therapists or voice teachers.
Prevention
To prevent vocal fold nodules, regular resting of the vocal cords is recommended, especially for people in occupations where the voice is heavily used. Herbal remedies can be taken to soothe the vocal cords.
Aftercare
With adequate rest of the voice, vocal fold nodules will regress on their own in most affected individuals. In this case, follow-up care is unnecessary. In rare cases, the nodules are more pronounced or do not regress on their own. Only then is surgery recommended at the discretion of the specialist. Afterwards, as after every surgical intervention, follow-up treatment is usual in order to control the healing process. If the symptoms of the affected person do not improve, it is important to find possible further causes. These can be both physical and psychological in nature. Once the actual origin of the symptoms has been identified, it is treated as part of the aftercare.The patient can take aftercare measures himself in the case of vocal fold nodules. Loud speech should be avoided, even if the nodules have already healed. If it is not possible to refrain from frequent speaking for professional reasons, a microphone can help to protect the voice at a conference or similar occasions. In this way, renewed nodule formation is prevented. Taking medicine, on the other hand, is not necessary. Inhaling moistens the mucous membranes and protects them from drying out. This has a positive effect on the healing process and prevents irritation.
What you can do yourself
Particularly advisable with vocal fold nodules is sparing. Affected people should talk as little as possible for a few days. This usually makes the hoarseness disappear by itself. If, on the other hand, the typical complaints occur again and again, a doctor should be consulted. Therapy will then be unavoidable. If voice blockages and hoarseness develop as a result of everyday work, patients should consider changing their job. People in speech professions in particular are otherwise unlikely to be able to meet the respective requirements. It is also advisable to avoid nicotine and alcohol altogether. Spicy foods can also cause voice problems. Clearing the throat and whispering are considered stressful for the vocal cords. Yawning, on the other hand, eliminates acute hoarseness and stretches the vocal folds. Likewise, regular breathing exercises and inhalations restore the voice. In the vast majority of cases, the doctor orders speech therapy sessions. The therapists are trained to address the individual problem and teach ways of acting in everyday life. Particularly in the case of chronic complaints, patients cannot avoid professional support. The question of whether surgical ablation will be necessary can also be discussed.
