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In order to understand how vocal pathologies occur we must first understand the anatomy and physiology of the airway and speech mechanism.  The vocal folds are house within the larynx, when you speak the air from your lungs moves from up to your larynx and to your mouth. The vocal folds vibrate in order to produce sound.

Vocal fold nodules are growths that form on the vocal folds. They are benign, or not cancerous. When you use your voice the wrong way, your vocal folds may swell. Over time, the swollen spots can get harder, like a callous. These nodules can get larger and stiffer if your vocal abuse continues.

Polyps can be on one or both of the vocal folds. They may look like a swollen spot or bump, a blister, or a thin, long growth. Most polyps are bigger than nodules. You may hear them called polypoid degeneration or Reinke’s edema. It may be easiest to think of a nodule as a callous and a polyp as a blister.

Signs of Vocal Fold Nodules and Polyps

Nodules and polyps cause similar symptoms. These include:

• hoarseness
• breathiness
• a “rough” voice
• a “scratchy” voice
• a harsh-sounding voice
• shooting pain from ear to ear
• feeling like you have a “lump in your throat”
• neck pain
• less ability to change your pitch
• voice and body tiredness

Causes of Vocal Fold Nodules and Polyps

Most of the time, vocal abuse or misuse causes nodules. Long-term vocal abuse can cause polyps, too. But polyps may happen after just one instance of vocal abuse, like yelling at a concert. Smoking cigarettes for a long time, thyroid problems, and reflux may also cause polyps.

Vocal abuse can happen in many ways, including from:

• allergies
• smoking
• tense muscles
• singing
• coaching
• cheerleading
• talking loudly
• drinking caffeine and alcohol, which dries out the throat and vocal folds

The Role of the Speech-Language Pathologist for Voice Disorders 

The first step of voice therapy is to assess the patient’s voice production and voice quality and structure the therapeutic program accordingly. Often, SLPs consult with otolaryngologists and neurologists to ensure a proper diagnosis.

If a voice disorder is suspected, SLPs first perform a screening. This generally involves evaluating vocal characteristics related to respiration, phonation, and resonance, as well as vocal range and flexibility.

If deviations from a normal voice are detected, SLPs suggest further evaluation through a comprehensive assessment. There are several standardized and non-standardized measures that SLPs use, and diagnostic therapy is often performed as part of the comprehensive assessment process.

SLPs look at a variety of factors when making an assessment, such as:

• Any impairments in the patient’s body structure and function that could affect sound production and verbal/nonverbal communication
• Any deficits, health conditions, or medications that can affect the voice
• The patient’s limitations (if any) in terms of activity or participation in interpersonal interactions
• The existence of any environmental or personal factors that may present obstacles to successful communication

A comprehensive assessment to identify voice disorders includes:

• Case history
  • Patient’s description of voice problem, including onset and symptoms
  • Medical status and history
  • Previous voice treatments
  • Daily habits related to vocal hygiene
• Self-Assessment: The patient’s assessment of how the voice problems affect:
  • The ability to communicate in social, work settings, and everyday activities
  • Emotions and self-image
• Oral-Peripheral Examination: Assessment of:
  • Structural and motor-based deficits that could affect communication
  • Symmetry and movement of the face, head, neck, and respiratory system
  • Sensation of the face and mouth
  • Taste and smell
  • Laryngeal sensations (burning, pain, tickling, dryness, etc.)
• Assessment of Respiration
  • Respiratory pattern
  • Coordination of respiration with phonation
  • Maximum phonation time
• Auditory-Perceptual Assessment
  • Voice quality (strain, pitch, loudness, overall sensitivity
  • Resonance
  • Phonation
  • Rate
• Instrumental Assessment, such as laryngeal imaging
• Acoustic Assessment
• Air Flow Assessment

-Sharon P. M.S. CF-SLP TSSLD