VOCAL NODULES, VOCAL FOLD NODULES, VOCAL CORD NODULES

Vocal nodules are the most common cause of hoarseness. Nodules are bilateral small swellings on vocal folds in the size of a lentil. They are usually bilateral and symmetrical. Vocal fold nodules are located at the junction of anterior one third and posterior two thirds of the free edges of vocal folds. Vocal cord nodules are also called singer’s nodules or kissing nodules. They are more commonly observed in women compared to men. They are closely related to psychological tension and aggressive personality. Vocal nodules appear on vocal folds due to bad and poor voice use, due to excessive vocal strain. People who excessively tense their neck and throat muscles during speech are especially prone to the development of vocal cord nodules. They are seen in people who speak loudly, yell frequently, scream very often and cry loudly. They are the problems of people who have to speak all day long, such as teachers, sales representatives, call center workers. They are commonly observed on professional voice users, such as singers, actors, actresses and politicians. They cause hoarseness, vocal fatigue, diplophonia and husky voice. The voice is usually scratchy. The patient does not have a clear and smooth voice. The patient may feel throat discomfort or pain after he spoke excessively.

The diagnosis of vocal fold nodules is done by ear-nose-throat examination and endoscopy of vocal folds through the nose or the oral cavity. Voice therapy is the treatment of choice for vocal nodules. During voice therapy, as the poor voice use habbits are removed and replaced by the correct voice use technique, vocal nodules regress in most of the cases. Voice therapy is a behavioral treatment. The correct phonation method is taught to the patient. The patient has to quit the tense phonation technique that he is used to. Relaxation of neck and throat muscles is advised. Correct method of inspiration and expiration is shown and practiced. The patient is required to attain soft phonation technique. Nodules that were left untreated for a long time and those unresponsive to voice therapy are surgically removed.

Hospitalization is not necessary for surgery of vocal nodules. The patient comes to the hospital with an empty stomach. He is taken to the operation room. He is made to sleep under general anesthesia. The surgeon inserts a metal tube (called laryngoscope) through patient’s mouth to his throat. A microscope is placed between the surgeon and laryngoscope to enlarge vocal folds. The surgeon removes vocal nodules through laryngoscope by using various long instruments. No incision is performed on any part of body of the patient. The operation takes around an hour. Two hours after surgery the patient is ready to go home. He is not allowed to drive home; somebody else has to drive him. There is food or drink restriction after nodule surgery. The patient has to obey a 7-day absolute voice rest postoperatively; speaking or whispering is strictly prohibited. During this voice rest communication is through writing. One day of throat pain is normal after surgery. Some of the patients may experience numbness on tongue and inability to taste foods for several weeks. This happens because nerves of the tongue is squeezed by the laryngoscope and it is always reversible. Vocal fold nodules are not cancerous and they do not convert to cancer leter. All vocal cord nodules do not require treatment. Many of the rock music singers have nodules and they are famous because of the nodules on their vocal folds. If their nodules disappear, their fans probably will not want to listen to their music any more. However, vocal nodules are nightmares for opera and Turkish art music singers and have to treated vigorously.