Vocal cord nodules
Summary/Definition
Vocal cord nodules are benign masses that appear on the vocal cords due to constant overload. They mainly occur in boys aged 6-7 years, women over 30 years of age, and in people whose profession requires an extensive use of the vocal cords (teachers, singers, etc.). They especially appear in children with cleft palate when the child begins to overload the larynx to compensate for pharyngeal dysfunction. Repeated vibration presses on the laryngeal mucosa and leads to submucosal oedema, circulatory retention, stasis and haemorrhage, basal membrane thickens, and fibrosis occurs, resulting in the nodule gradually turning hard.
When examined with the naked eye, vocal cord nodules are divided into soft and hard nodules. Soft nodules are most often found in women, especially when the voice is overworked or overstressed. Hard nodules are more common in people whose occupation involves frequent use of the voice and are typified by grey-white hard nodules.
Symptoms
The main symptom is a change in the voice, such as hoarseness, which often results in a strained, coarse sound. It often recurs after voice overload or an upper respiratory tract infection. These changes are more painful in normal speaking or singing, and the nodules interfere with vocal cord vibration and cause delayed sound production, intermittent or uneven sound on high notes, and “splitting” of the sound. The size, symmetry and color of the nodules vary depending on the progression of the disease, the load on the larynx, etc. The nodules are usually bilateral but may be accompanied by microvascular enlargement. The nodules are about the size of a grain of millet or rice and most commonly occur at the border of the anterior or middle third of the vocal cords.
Diagnostics
During medical history assessment, the doctor investigates whether the patient smokes, uses the voice in daily life, and performs endoscopic laryngoscopy and soft endoscopy of the larynx. The presence or absence of sound waves of the laryngeal mucosa must be accurately determined by microvibration testing. Tests can also be carried out to detect nodular cysts, which are characterized by an interruption in the vibration of the vocal cords during the microvibration test. However, if the cysts are small, they are difficult to detect and are usually discovered during surgery.
Treatment and course of the disease
Conservative treatment includes vocal stabilization, voice therapy and treatment of pharyngeal reflux disease. Voice therapy can improve symptoms by more than 80 percent, mainly by using the gentlest possible voice training at home or ‘silent therapy’. Chronic vocal cord nodules are difficult to cure with conservative treatment alone. Inhalation therapy may also help to lubricate the laryngeal mucosa. If voice problems persist for 3 months or more despite conservative treatment, surgery may be considered. Surgical treatments include laryngeal microsurgery using forceps, CO2 and laser, and the microflap technique. After surgery, the voice needs to rest to allow the mucous membrane to regenerate at the site of the removed nodule.
Complications
If vocal cord nodules are left untreated for a long period of time, irreversible changes in the voice may occur and the original voice may not be restored even after surgery. Excessive strain on the vocal cords after surgery is one of the causes of nodules recurrence. In addition, constant overloading of the ligaments can cause them to thicken.
Vocal cord nodules are cured in most cases with appropriate treatment. However, they can recur, so it is important to use and manage your voice properly.
