Specialist ENT VOCAL NODULES

VOCAL NODULES

Vocal nodules occur due to overtaxing and voice abuse. They are also called Singer’s or Screamer’s nodules.

Aetiology:

  1. Age: Usually occur after puberty.
  2. Sex: More common in females.
  3. Occupation: Seen in untrained singers, teachers, hawkers, housewives and others who require regular loud talking.

Causes:

  1. Vocal abuse– Screaming, shouting, continuous loud talking, forceful throat clearing etc. This is seen in untrained singers, teachers, hawkers etc.
  2. Vocal misuse– This means talking in inappropriate pitch and loudness.

Pathology of Vocal Nodules:

Vocal nodules usually occur on both cords over a period of time, commonly at the junction of anterior and middle one third of the vocal cords. In children and adolescents, the misuse of voice leads to spindle shaped thickening at the edges of the vocal cords. In adults, the swellings are more localized forming vocal nodules. The epithelium over the edges of the vocal cords undergoes hyperkeratosis resulting in disturbed mucosal waves. Microscopically, there is submucous transudation followed by ingrowth of vessels and fibrous organization.

Clinical features:

  1. Hoarseness of voice as the nodules interfere with normal vibrations of vocal cords.
  2. Vocal fatigue.
  3. Inability to sing too high or low tones.

Investigations:

1. Indirect laryngoscopy shows vocal nodules typically form at the junction of anterior one-third with posterior two-thirds of vocal cords.

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2. It is confirmed by fibre optic laryngoscopy or by Hopkins 70-degree endoscope in OPD.

3. Video Stroboscopy- Stroboscopy is a special method of examination of a vibration of vocal folds. A bright flashing light lasting a fraction of a second (10µs) is used to illuminate the vocal folds. This flash ‘freezes’ the movement of the vibrating vocal folds. By taking multiple snapshots at different phases of the vibratory cycle it is possible to see details of the change in shape of pliable surface of the vocal folds (i.e. the mucosa) with time.

Treatment:

Medical treatment

Surgical treatment

Voice rest

Speech therapy

Steam inhalation helps to reduce oedema around vocal cords in cases of laryngitis

Regular fluid intake.

Avoid alcohol, caffeine, spicy food, smoking

Excision by Microlaryngoscopy

Excision by Laser Microlaryngoscopy

Excision by cold steel instruments

Excision by Radiofrequency.

Speech therapy is required in most post-operative cases



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