Vocal Nodules

What are Vocal Nodules?

Vocal nodules also known as Singer’s nodes or Singer’s nodules are callouses that are developed on the vocal folds which are formed as the outcome of a vocal cord trauma. Vocal folds are not just some strings in the voice box but are folds of tissue with a sensitive lining on the outside.

vocal folds vocal cord nodules



The lining is very soft like the ones on the inside of the cheek which can be easily injured. When the vocal folds intensely collide, swelling will form around the site where it collided.

One episode of trauma recovers for days of resting; but if these episodes happen over and over again, the swelling becomes more persistent as well and treatment will then be required.

Soft nodules mainly refer to the existing swelling discomfort. If soft nodules are just ignored, it will progress and will start to create fibrous scar tissue making the area that is affected get stiffer and cannot vibrate successfully. These are then called hard nodules and are much harder to treat since they do not just resolve with voice therapy. Vocal fold nodules commonly develop in children and in both sexes.

What are the Signs and Symptoms of Vocal Nodules?

Nodules of the vocal cords lessen the ability of the vocal folds to produce rapid changes in air pressure which create human speech. Individuals usually are prone to vocal nodules especially if their voices are used as a means of their living such as a singing career.

Signs like neck pain or tightness and discomfort in the throat will be most-likely felt. At the onset of the trauma, the voice may become a bit husky and the ability to hold a specific pitch range cannot be obtained, losing brightness and clarity.

The hoarseness of the voice is clear while speaking or singing and the higher notes are not easily reached. It may also begin to cut out on some notes, giving characteristic voice breaks making it more noticeable when the voice is quietly used. Singing quietly can’t even be done.

What are the Causes of Vocal Nodules?

Vocal folds vibrate for about seven hundred times per second when speaking or singing. These actions put a lot of stress on the delicate lining of the vocal cord. Singing or speaking incorrectly such as in dry and smoky places, or for prolonged use of the vocal cords can cause the lining to swell.

In most cases, nodules are often caused by the misuse or abuse of the vocals like coaching, bad techniques in singing, cheerleading, shouting, coughing, and even the intake of alcohol and caffeine can dry the throat and vocal cords.


Diagnosis

A correct diagnosis is essential for treating vocal nodules. If a hoarse voice had been experienced for more than 3 weeks already, the physician should be approached to have a thorough evaluation of the voice. The patient will be examined preferably by a laryngologist who specializes in voice disorders and diseases of the larynx and evaluated by a speech-language pathologist.

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A neurological examination can also be possible. They will assess the patient’s vocal quality, loudness, and other voice characteristics. Another examination with the use of an instrument may also take place, which involves inserting an endoscope in the nose or mouth to view the larynx and vocal cords. The use of stroboscope might be needed as well to assess the movement of the vocal cords.

How are Vocal Nodules Treated?

The most effective treatment time of vocal nodules is when they are caught early and properly diagnosed. Nodules can be treated behaviorally, medically, or surgically. Almost all cases of vocal nodules are successfully treated. They might resolve on their own with rest alone even in their severe stage; but if the trauma episodes are recurring, then treatment is a must.

The first option is usually voice therapy wherein good vocal hygiene is taught, direct voice treatment is done to make adjustments with loudness or pitch, breath support, and vocal exercises to restore productive vocal function.

If the nodules become hard or if there are time limitations like a specific training, surgical treatment might be the fastest and most effective solution.

Voice therapy is still required after surgery in order to rebalance the production of the voice and prevent recurrence.

References:

Voice Disorders Information: When is a Nodule not a Nodule?,  Surgery Now and Then – http://www.britishvoiceassociation.org.uk/voice-information_vocal-nodules.htm

What treatments are available for nodules and polyps? at http://www.asha.org/public/speech/disorders/NodulesPolyps/#c

El Uali Abeida M, Fernández Liesa R, Vallés Varela H, García Campayo J, Rueda Gormedino P, Ortiz García A (2011 Nov 14). Study of the Influence of Psychological Factors in the Etiology of Vocal Nodules in Women. J Voice.

Cipriani NA, Martin DE, Corey JP, Portugal L, Caballero N, Lester R, et al (2011 Oct. 19). The Clinicopathologic Spectrum of Benign Mass Lesions of the Vocal Fold due to Vocal Abuse. Int J Surg Pathol. (5):583-7.


Yamasaki R, Behlau M, Brasil Ode O, Yamashita H (2011 Nov. 25). MRI anatomical and morphological differences in the vocal tract between dysphonic and normal adult women. J Voice. (6):743-50.


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