Health Care and Throat Nodules (Nodes)

Do you know anyone who has suffered from nodes or nodules on their vocal chords? Typically it comes from overuse of the throat and vocal chords by singers, public speakers and others who do a lot of talking or singing for a living. Many performers deal with it as part of their hazardous vocal needs. Sometimes it is called "Screamer's Voice."

According to the American Academy of Otolaryngology (AAO), the term vocal cord lesion refers to a group of noncancerous (benign), abnormal growths (lesions) within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems and are generally seen in three forms; nodules (nodes), polyps, and cysts.

The AAO says that vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped. More details are found at their site: http://www.entnet.org/content/nodules-polyps-and-cysts .

Nodules and polyps, according to the American Speech-Language-Hearing Association, cause similar symptoms:

·         Hoarseness

·         Breathiness

·         A "rough" voice

·         A "scratchy" voice

·         Harshness

·         Shooting pain from ear to ear

·         A "lump in the throat" sensation

·         Neck pain

·         Decreased pitch range

·         Voice and body fatigue

If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include:

·         a physician's examination, preferably by an otolaryngologist (ear, nose, and throat doctor) who specializes in voice,

·         a voice evaluation by a speech-language pathologist (SLP), and

possibly a neurological examination.

The team will evaluate vocal quality, pitch, loudness, ability to sustain voicing, and other voice characteristics. An instrumental examination may take place that involves inserting an endoscope into the mouth or nose to look at the vocal cords and larynx in general. A stroboscope (flashing light) may be used to watch the vocal cords as they move. Much more detail on vocal nodes is located at this site: http://www.asha.org/public/speech/disorders/NodulesPolyps/ .

A doctor makes the diagnosis by examining the vocal cords with a mirror or a thin, flexible viewing tube (laryngoscopy), according to Merck Manuals. Sometimes the doctor removes a small piece of tissue for examination under a microscope (biopsy) to make sure the growth is not cancerous (malignant).

Treatment is to avoid whatever is irritating the voice box (larynx) and rest the voice. If abuse of the voice is the cause, voice therapy conducted by a speech therapist may be needed to teach the person how to speak or sing without straining the vocal cords. Most nodules and granulomas go away with this treatment.

Granulomas that do not go away can be removed surgically but tend to come back. Most polyps must be surgically removed to restore the person's normal voice. More info can be found at this website: https://www.merckmanuals.com/home/ear,-nose,-and-throat-disorders/mouth-and-throat-disorders/vocal-cord-polyps,-nodules,-and-granulomas .

According to the British Voice Association, if you have symptoms that suggest you may have vocal nodules:

·         Seek a medical opinion from a Laryngologist experienced with voice problems. The best solution is to ask your primary care doctor for a referral to a multidisciplinary voice clinic.

·         Whenever possible rest your voice and avoid speaking against noise, shouting or coughing violently.

·         Inhale steam to soothe irritated and swollen vocal folds.

·         Keep well hydrated and avoid inhaled irritants, such as smoke.

·         If you are a singer discuss suitable warm up exercises with your singing teacher and do not try to sing high and quiet – you will be doomed to disappointment until the nodules have resolved.

·         If your Laryngologist refers you to a speech and language therapist take up the option and work hard on the exercises you are given. Voice therapy is like physiotherapy or Pilates for the voice and may well be all you need to resolve the nodules.

·         If your Laryngologist suggests surgery, do not panic! It may well be the quickest and most effective way to deal with the problem. Ask your Laryngologist to explain exactly what they will do at surgery and why they feel it is the best treatment option. Discuss any worries you have openly.

·         Don't beat yourself up about it! Vocal nodules are not a crime or even necessarily the result of "bad technique". They are an injury, much as a marathon runner might sustain during training or a race.

Although vocal nodules remain a problem for professional voice users and may cause some cancelled shows, delays in training, a lot of hard work and inevitably some anxiety, they are very unlikely to herald the end of a career. More details are located at this site: http://www.britishvoiceassociation.org.uk/voice-information_vocal-nodules.htm .

Having nodules or nodes on your throat should not be taken lightly. Seek professional medical advice to help your situation. Your doctor can prescribe treatment or suggest more advanced options for care. Don’t continue to ignore the symptoms, and do what the doctor says!

Until next time.