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I have recently worked with an individual who came to our office for voice therapy secondary to severe vocal nodules. I found this case to be extremely interesting and it inspired this weeks blog topic.  Below you will find information about what vocal nodules and polyps are, what causes them, and the harmful effects they can have on your voice. I hope you find this interesting!

What are vocal cord nodules and polyps?

Vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse. Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues.

Polyps can take a number of forms. They are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal cords. They appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke’s edema. The best way to think about the difference between nodules and polyps is to think of a nodule as a callous and a polyp as a blister.

What are signs and symptoms of vocal cord nodules or polyps?

Nodules and polyps cause similar symptoms:

• hoarseness
• breathiness
• a “rough” voice
• a “scratchy” voice
• harshness
• shooting pain from ear to ear
• a “lump in the throat” sensation
• neck pain
• decreased pitch range
• voice and body fatigue

How are nodules and polyps diagnosed?

If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include:

• a physician’s examination, preferably by an otolaryngologist (ear, nose, and throat doctor) who specializes in voice,
• a voice evaluation by a speech-language pathologist (SLP), and
• possibly a neurological examination.

The team will evaluate vocal quality, pitch, loudness, ability to sustain voicing, and other voice characteristics. An instrumental examination may take place that involves inserting an endoscope into the mouth or nose to look at the vocal cords and larynx in general. A stroboscope (flashing light) may be used to watch the vocal cords as they move.

What treatments are available for nodules and polyps?

Nodules and polyps may be treated medically, surgically, and/or behaviorally. Surgical intervention involves removing the nodule or polyp from the vocal cord. This approach only occurs when the nodules or polyps are very large or have existed for a long time. Surgery is rare for children. Medical problems may be treated to reduce their impact on the vocal cords. This includes treatment for gastroesophageal reflux disease (GERD), allergies, and thyroid problems. Medical intervention to stop smoking or to control stress is sometimes needed.

Many people receive behavioral intervention, or voice therapy, from an SLP. Voice therapy involves teaching good vocal hygiene, reducing/stopping vocal abusive behaviors, and direct voice treatment to alter pitch, loudness, or breath support for good voicing. Stress reduction techniques and relaxation exercises are often taught as well.

What causes nodules and polyps?

Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by long-term vocal abuse but may also occur after a single, traumatic event to the vocal cords, such as yelling at a concert. Long-term cigarette smoking, hypothyroidism, and GERD may also cause polyp formation. Below are some vocally abusive behaviors:

• allergies
• smoking
• tense muscles
• singing
• coaching
• cheerleading
• talking loudly
• drinking caffeine and alcohol (dries out the throat and vocal cords)

-Lindsay

Information retrieved from: http://www.asha.org/public/speech/disorders/NodulesPolyps/