Vocal fold nodule
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|Vocal voice nodule|
|Classification and external resources|
A vocal fold nodule is a mass of tissue that grows on a vocal fold. Typically this mass appears on the junction of the anterior 1/3 and posterior 2/3 of the vocal fold, where contact is most forceful.
A vocal fold nodule reduces the ability of the vocal folds to create the rapid changes in air pressure which generate human speech. Symptoms include hoarseness, painful speech production, frequent vocal breaks, and reduced vocal range. Hoarseness or breathiness that lasts for more than two weeks may signal a voice disorder and should be followed up with an otolaryngologist.
Vocal fold nodules develop mostly in adult women and in children of both sexes. The nodules appear as symmetrical swellings on both vocal cords. The cause of these formations is usually strenuous or abusive voice practices that leads to inflammation caused by stress or irritation  such as yelling, poor singing techniques, and coughing. Those who use their voices constantly in a loud environment are susceptible.
Grossly: these inflammatory polyps are smooth, hemispheric protrusions (less than 0.5 cm in diameter), located most often on the true vocal cords and are usually bilateral.
Vocal fold nodules can certainly impair one's speaking and singing ability. They rarely harm one's general health. However, the psychological trauma of being diagnosed with nodules—a trauma affecting those especially whose professional success depends on consistently using a rich and powerful vocal tone (e.g. singers, actors, broadcasters)—typically dwarfs the limited systemic and even otolaryngological effects.
Treatment, or voice rehabilitation, usually involves vocal training, voice therapy, and, occasionally, vocal rest. Behavioural voice therapy with a speech-language pathologist is recommended. In rare cases, surgery may be required when behavioural interventions are ineffective. Removal of vocal fold nodules is a relatively safe and minor surgery. However, those who sing professionally or otherwise should take serious consideration before having surgery as it can affect the ability to sustain notes, as well as alter the vocal range. Examples of this are Julie Andrews, Ryan Key, and José José, who lost much of their singing ability after undergoing surgery to correct vocal nodules. However, a lot of the time the surgery is very successful and leads to a full recovery of the voice, as with the Icelandic singer Björk.
Surgical treatments are considered in cases of unresolving dysphonia which negatively impacts the patient's quality of life. While the patient is subdued under general anesthesia, long thin scissors and scalpels are used to remove the nodules, or CO2 surgical lasers might be used which are very effective in such cases.
- Karkos, Petros D; McCormick, Maxwell. "The etiology of vocal fold nodules in adults". Current Opinion in Otolaryngology & Head and Neck Surgery. 17 (6): 420–423. doi:10.1097/moo.0b013e328331a7f8.
- "Vocal fold nodule vs. vocal fold polyp: answer from surgical pathologist and voice pathologist point of view". Journal of Voice. 18(1), 125-129.
- Blake Simpson, Clark Rosen, Hans Von Leden, Robert H. Ossoff (2008) Operative Techniques in Laryngology
- Vocal fold nodule vs. vocal fold polyp: answer from surgical pathologist and voice pathologist point of view.Wallis, Lesly et al.Journal of Voice , Volume 18 , Issue 1 , 125 - 129
- "Vocal Fold Nodules". Current Opinion in Otolaryngology & Head and Neck Surgery. 4(3), 166-171.