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Vocal Nodule

Otolaryngology

Vocal cord nodules, commonly known as vocal cord calluses, vocal cord nodules or singer's nodules, are benign growths or nodules on the vocal cords. They typically appear at the contact points of the vocal cords, which are the areas that vibrate the most during phonation. These nodules are primarily caused by excessive or improper use of the vocal cords, leading to inflammation and swelling, and eventually, the skin thickens and forms nodules.

Typical symptoms of vocal cord nodules include:

Hoarseness lasting more than two weeks, voice changes, breathiness, loss of voice, and throat pain.
Vocal fatigue, especially after prolonged speaking or using the voice.
Limited vocal range.
A sensation of a foreign body or pressure in the throat while speaking or singing.

Causes

The primary causes of vocal cord nodules include:

Overuse of the vocal cords: Prolonged and intense use of the vocal cords is the most common cause of nodule formation. It includes loud speaking, extended speaking, singing, and screaming, which place high tension on the vocal cords.
Poor vocal technique: Incorrect vocal techniques, such as excessive force or improper use of the vocal cords, can also lead to nodule formation. Professionals who frequently use their voices, such as public speakers, singers, and teachers, are particularly susceptible.
Chronic vocal fatigue: Long-term vocal fatigue can subject the mucous membrane on the vocal cords to continuous pressure, potentially leading to nodule formation.
Vocal cord injury: A single severe vocal cord injury, such as that caused by loud yelling, can also result in the development of nodules.
Vocal cord dryness: Lack of adequate lubrication, leading to dryness of the vocal cord surface, can increase the risk of nodule formation.

Vocal cord nodules are mainly caused by repeated friction or collision of the vocal cords. Prolonged overuse and stress can lead to the thickening and hardening of vocal cord tissue, forming nodules, which then affect the clarity and quality of the voice.

Risk Factors

Various factors, including the following major risk factors, influence the formation of vocal cord nodules:

Occupational factors: Frequent use of the vocal cords is a primary risk factor for vocal cord nodules. Professions that require extensive voice use, such as teachers, actors, singers, salespeople, and performers, are more prone to developing vocal cord nodules.
Improper vocal technique: Incorrect vocal techniques, such as consistently exerting excessive force or using improper vocal methods, can increase the risk of vocal cord damage and lead to nodule formation.
Gender and age: Studies indicate that women and children have a higher incidence of vocal cord nodules, which may be related to differences in vocal cord structure and usage patterns.
Lifestyle habits: Smoking and excessive alcohol consumption can damage the vocal cords and increase the risk of nodules.
Chronic vocal fatigue: Continuous overuse of the vocal cords without adequate rest can lead to vocal fatigue and the formation of nodules.
Health conditions: Certain chronic illnesses, such as thyroid disorders and gastroesophageal reflux disease (GERD), can affect vocal cord health and increase the likelihood of nodule formation.
Environmental factors: Prolonged exposure to dry, dusty environments or air pollutants can strain the vocal cords and contribute to nodule development.

Diagnosis and Treatments

Diagnostic Methods

Laryngoscopy	The most common diagnostic method is laryngoscopy, where a doctor uses a laryngoscope to observe the patient's vocal cords. It can be done through direct or indirect laryngoscopy using a fiberoptic laryngoscope.
Acoustic Analysis	Acoustic analysis can evaluate the quality and other parameters of the voice, helping doctors understand vocal cord function.
Stroboscopy	Stroboscopy uses special imaging techniques to observe the vibration patterns of the vocal cords during phonation. It helps in a detailed assessment of the dynamic behaviour of the vocal cords.

Treatment Methods

Behavioural Therapy	Voice Rest: Reducing the use of the vocal cords to allow them to recover. Vocal Training: Working with a speech therapist to practice proper phonation techniques and learn to use the vocal cords effectively without causing excessive strain.
Medication Therapy	Anti-inflammatory Medications: In some cases, anti-inflammatory drugs may be used to reduce inflammation of the vocal cords. Hormone Therapy: In rare instances, hormone therapy may be used to reduce swelling of the vocal cords quickly.
Surgical Treatment	If vocal cord nodules significantly affect the patient's voice and conservative treatments are ineffective, a doctor may recommend surgical removal of the nodules. Surgery is usually minimally invasive and performed through a laryngoscope.
Lifestyle Adjustments	Avoid Smoking and Secondhand Smoke: Smoke irritates the vocal cords and exacerbates problems. Maintain Good Hydration: Keeping the body hydrated helps maintain vocal cord lubrication. Avoid Overuse or Misuse of Voice: Avoid yelling and prolonged high-intensity voice use.

The focus of treating vocal cord nodules is reducing vocal cord stress and inflammation and improving voice usage techniques through behavioural and acoustic training. Early intervention and appropriate treatment can significantly improve symptoms and prevent the need for surgery.