Vocal Fold Nodules

NODULES AND POLYPS – SEE POWER POINT

Description. Nodules and polyps are common, benign (non-cancerous) growths that develop at the middle of the vocal folds. Mature nodules are similar to “calluses” within the vocal fold tissue and usually develop on both vocal folds. Polyps tend to be more fluid-filled than nodules, and visible blood vessels may feed into them. Polyps may develop on one or both vocal folds. Typical symptoms for both nodules and polyps include hoarseness, effortful voice, and rapid vocal fatigue.

Causes. Both nodules and polyps are thought to be caused by vocal fold trauma during talking or singing. The reason is that the middle of the vocal folds, where the growths occur, receives the greatest amount of impact during voice production. Other factors any also increase the likelihood that nodules or polyps will develop. Such factor include smoking, alcohol use, caffeine, drying medications, allergies, exposure to noxious chemicals, and gastric reflux.

Treatments.

  • Behavioral modification is the primary treatment of mucosal lesions and is likely a lifelong treatment of the problem. For example, if the patient is a singer, it is usually not the singing that is the problem. More often it is the amount of talking that goes on daily. They need to take a look  at their life, perhaps in conjunction with a speech therapist, to decide where they can rest their voices.
  • Many times managing their talkativeness will reduce a vocal fold swelling to an acceptable size such that the voice becomes dependable and acceptable to the patient.
  • Hemorrhage can generally be managed behaviorally, particularly if it was from a one time indiscretion.
  • Traditional voice therapy consists of two primary avenues.
  • Vocal hygiene is a daily regimen to achieve and maintain a healthy voice. It includes maintaining adequate hydration (6-8 glasses of water per day), minimizing exposure to noxious chemicals, no smoking of cigarettes, and the avoiding of excessive shouting, screaming or other loud voice use.
  • Voice therapy is a behavioral intervention technique that makes use of vocal exercises, speaker awareness and proper postures and alignment when using the voice.
  • For nodules, in some cases, after therapy has been completed, voice is improved but is not yet back to normal. In such cases, patients may wish to talk with their physicians about laryngeal microsurgery and its possible benefits or medical management.
  • For polyps, voice therapy may be recommended as first part of treatment, as for nodules. However, in some cases surgery is recommended first, followed by voice therapy.

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