Vocal cord nodules

At Vocal cord nodules it is thickening on the edge of the vocal folds. They are also called Scream nodules, Singer nodule or Vocal cord nodules designated. The thickened elevations are often mirror-inverted and comparable to the development of calluses on normal skin. As a result of the vocal cord nodules, the vibration sequence on the vocal cord mucosa is disturbed. The normal closure of the vocal folds is also affected.

What are vocal cord nodules?

Vocal cord nodules are among the so-called organic voice disorders. They form on the vocal folds and appear in the form of double-sided nodules. If the vocal folds are no longer able to vibrate freely as a result of mechanical overload, corresponding nodules can form.

In the process, the initially soft vocal nodules develop into hard thickenings after prolonged exposure. These form at the points that are under the highest pressure when the voice is used and are initially covered by threads of mucus. Vocal cord nodules are an extreme form of what is known as hyperfunctional dysphonia.

Usually they lead to hoarseness and hoarse voice with the constant feeling of having to clear your throat. Basically, vocal cord nodules only occur in women. Men, on the other hand, can only get sick with the so-called singer's nodules, which mainly affect tenors.

causes

Vocal cord nodules are the result of long-term voice overload. An unphysiological voice technique is responsible for this overuse. However, there are a number of other possible causes for the organic changes that show up in the vocal cords.

Most of the time, voice overuse or improper voice stress is the underlying cause of vocal cord nodules. This happens, for example, with people who regularly speak in noise. A wrong vocal technique means that speaking takes place with an unusually high amount of physical effort and pressure. Vocal cord nodules occur in singers especially when they often sing in the wrong pitch and the voice is overwhelmed.

In this case, the vocal cord nodules are called singer's nodules. In children, vocal cord nodules very often develop as a result of loud and frequent speaking. Here the thickenings on the vocal cords are called scream nodules. In addition, people who are hard of hearing are often affected by vocal cord nodules because they often speak too loudly and put the wrong strain on their voice.

Symptoms, ailments & signs

The typical symptoms of vocal cord nodules can be diverse and vary depending on the severity and location of the thickening on the vocal cords. In the majority of cases, vocal cord nodules are expressed by a hoarse and rough voice. It is difficult to speak, and sometimes the voice fails.

Sometimes there is a feeling of a foreign body while speaking. In addition, many affected people have the urge to clear their throat frequently. However, in most cases this does not help to reduce the paresthesia in the vocal cords and the urge to clear the throat occurs again. The voice can be increasingly less stressed as a result of the vocal cord nodules.

The changes on the vocal folds form on their edge. The vocal cord nodules often occur in the transition area from the front to the middle third of the vocal folds. If the mood is overloaded, a slight edema forms here, which, however, regresses again by protecting the voice.

If the load continues, the edema increases. Soft nodules develop, which turn into hard vocal cord nodules if the overload persists. If the nodules are particularly large, a so-called hourglass glottis is created.

Diagnosis & course of disease

A number of examination-technical methods and measures are available for the reliable diagnosis of vocal cord nodules, the choice of which the treating physician decides after examining the individual case. It is generally advisable to consult an ear, nose and throat specialist if you suspect the presence of vocal cord nodules.

If possible, see a phoniatric doctor who specializes in voice disorders. In the course of a reflection of the larynx, the doctor is able to examine the vocal organ of the person concerned more closely. This makes it possible to detect organic changes in the vocal folds, for example in the form of nodules. In addition, the doctor can identify the type of nodules present during the larynxoscopy. The presence of soft or hard nodules allows conclusions to be drawn about the development of the vocal cord nodules.

Complications

The foreign body sensation typical of vocal cord nodules means that those affected often clear their throats and thus put additional strain on the vocal cords. As the disease progresses, the stress on the voice becomes less and less and inflammation or edema occasionally develop. If the load is not reduced, the edema increases - more nodules develop and the symptoms increase.

With particularly pronounced nodules, a so-called hourglass glottis, a pathological change in the vocal cords, can arise. If left untreated, the voice may be lost completely. There are usually no complications involved in treating vocal cord nodules. Speech therapy is usually ordered, which can cause further problems in the event of a misdiagnosis. If pain relievers or anti-inflammatories are prescribed because of severe discomfort, problems can sometimes arise.

This can lead to side effects and interactions that cannot always be foreseen before taking the preparation. Typical complaints include gastrointestinal problems, cardiovascular complaints or headaches and body aches. Patients who suffer from another disease or who are already taking another medication are particularly at risk for possible interactions.

When should you go to the doctor?

As a rule, if you have a vocal cord nodule, you should always see a doctor. Only through an early visit to a doctor and subsequent treatment can further complications or complaints be prevented. Self-healing does not occur and symptoms worsen if the vocal cord nodules are left untreated. A doctor should be consulted with this disease if the person concerned can no longer speak easily. Speaking itself is usually difficult for the patient, which also leads to permanent hoarseness.

In many cases, those affected have to constantly clear their throat, which further damages the vocal cords. If these symptoms occur, a doctor must be consulted immediately so that the vocal cords are not further damaged by the vocal cord nodules. As a rule, the vocal cord nodules can be treated relatively well by an ENT doctor or a general practitioner.

Treatment & Therapy

The treatment of vocal cord nodules depends on the consistency of the nodules present. For soft vocal cord nodules, the doctor usually prescribes vocal rest. In the case of speaking professions, this is often only possible with a sick leave. Speech therapy can also be prescribed to reduce the number of incorrect voice techniques.

Since this is often associated with a longer absence from work, soft vocal cord nodules are increasingly surgically removed. Even with hard nodules, vocal calm is recommended. In most cases, the hard vocal cord nodules are removed by surgery.

The patient then undergoes speech therapy training. The perception of your own voice and breathing is trained and hearing skills are trained. The therapy is carried out by trained voice therapists, such as speech therapists or voice teachers.

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prevention

Regular protection of the vocal cords is recommended to prevent vocal cord nodules, especially for people in professions in which the voice is very demanding. Herbal remedies can be taken to calm the vocal cords.

Aftercare

If the voice is spared enough, vocal cord nodules recede on their own in most people affected. Follow-up care is unnecessary here. In rare cases the nodes are more pronounced or there is no independent regression. Only then is an operation recommended at the discretion of the specialist. Afterwards, as after every surgical procedure, follow-up treatment is usual in order to control the healing process.

If the symptoms do not improve in those affected, it is important to find possible further causes. These can be both physical and psychological in nature. After the actual origin of the symptoms has been identified, it is treated as part of the follow-up care.

The patient can take remedial measures himself for vocal cord nodules. Speaking loudly should be avoided even after the lumps have healed. If it is not possible to do without frequent speaking for professional reasons, a microphone can help protect the voice at a conference or similar occasion.

This prevents re-knotting. However, it is not necessary to take medicine. Inhaling moisturizes the mucous membranes and protects them from drying out. This has a positive effect on the healing process and prevents irritation.

You can do that yourself

It is particularly advisable to take care of vocal cord nodules. Those affected should talk as little as possible for a few days. As a result, the hoarseness usually disappears on its own. If the typical symptoms recur, however, a doctor should be consulted. Therapy then becomes inevitable.

If voice blocks and hoarseness develop out of everyday work, patients should reconsider changing their job. Otherwise, people in speaking professions will hardly be able to meet the respective requirements. It is also advisable to completely avoid nicotine and alcohol. Spicy foods can also cause voice problems. Throat clearing and whispering are considered stress on the vocal cords. Yawning, on the other hand, eliminates acute hoarseness and stretches the vocal folds. Regular breathing exercises and inhalations also restore the voice.

In the majority of all cases, the doctor orders speech therapy sessions. The therapists are trained to deal with the individual problem and to convey actions for everyday life. Especially with chronic complaints, patients cannot avoid professional support. The question of whether surgical removal is necessary can also be discussed.