Vocal nodules are swellings on the vocal cords and they always appear in pairs so you have
a right vocal cord with a swelling and a left vocal cord with a swelling. And we tend to
see them in professions of heavy voice use such as presenters, teachers, telephonists.
We also occasionally see them in singers where they’re performing excessively and perhaps
in a suboptimal technique or in a vocal register that isn’t their natural vocal register.
Vocal cord nodules are essentially an injury and what you have is a poor closure technique,
rather than the vocal cords closing on a broad front, they’re tending to make first contact
in the middle. And that becomes a pressure point so if you’re using your voice excessively,
you’re not giving the voice enough rest. You’re not doing warm-up if you’re a performer.
You tend to get a swelling here almost like a blister. And if you had those repaired with
voice rest, then that blister will resolve. But if you carry on over time, they get bigger
and they can ultimately end up calloused and permanent so they’ll be refractory to treatment
with a speech therapy. Vocal nodules can give you a rough quality
to your voice and if you use your voice over a prolonged period, it can also give you vocal
fatigue and give you aches in the neck because you’ve actually have to try harder to bring
the vocal cords together because of the gap that now exists before and after the nodule.
They also affect the vibration. Now there are some people who wouldn’t actually
notice that they have vocal nodules. Some singing stars like rock performers actually
it adds character to their singing voice so they may not want anything done about them.
But certainly, if someone with a more purer voice or say a teacher who has to talk for
many hours, this rough quality can get worse and they can suffer vocal fatigue.
Vocal cord nodules give you a rough quality to your voice. There are other things that
will give you a rough quality to your voice. If you’ve had cold or flu, you may have
laryngitis and you may have a rough voice that subsequently gets better. But if we’re
looking at pathology on the vocal cords, nodules is one of the pathologies you could have a
cyst, you could have swelling from acid reflux, you could have some kind of benign growth
on your vocal cords, or if you’re a smoker and you have been smoking for quite a while,
you could actually have a small tumor or growth on your vocal cords.
So that guidelines are that if your voice has been poor or has been rough for more than
three or four weeks and this isn’t something that you tend to suffer on a regular basis
and have had looked at previously, you should have your vocal cords looked at and assessed.
Vocal nodules are a contact injury on the vocal cords and they occur because either
you’ve overdone it with a voice or you’ve overdone it with a poor vocal technique if
you’re a performer. In most cases, if you had a period of rest and your vocal nodules
have been there a short time, they will disappear. But obviously, you cannot do this with everyone
and management, in most cases, in the first instance, has to be speech therapy and the
speech therapies will take the patient through good vocal habits, hydration, warm-ups, and
also tell them about having a quiet time where they have vocal breaks. The vast majority
of vocal nodules will resolve by management in the hands of a speech therapist. It is
very rare and it should be very rare that vocal nodules go on to have surgery. And surgery
is straightforward when it occurs. It’s usually a day case procedure.
The patient under general anaesthesia will have an instrument pass through the mouth
that visualises the vocal cords and under the microscope, they can be removed. But one
of the downsides of having surgery on the vocal cords is that there is prolonged recovery
period. They will have to have complete voice rest for a number of days and then minimal
voice usage for another two weeks or so before they then are delivered to a speech therapist
to gradually build them up to normal activity.