What are Singer’s nodules (vocal nodules)?

Vocal Nodules

Singer’s nodules are small nodules that usually form on the vocal cords as a result of excessive or improper use of the vocal cords. They might be easily reversible if detected early and treated accordingly. However, in chronic cases, they need to be removed with endoscopic surgery.

The right and left vocal cords are dynamic structures that regulate the breathing as well as the voice. During breathing, the vocal cords open to allow for maximum air exchange. During vocalization, the vocal cords come together, and as air goes from the lungs into the throat, the vocal cords vibrate to generate our voice. If a person has been overusing their voice or yelling or misusing the voice, trauma from excessive closure of the vocal cords can have negative results. Typically, the region of the most forceful contact is the junction between the front one-third and the back two-thirds of the vocal cords. If the vocal cords have been slamming against each other because of voice abuse, swelling can result in this area. The initial symptoms are that of raspy quality to the voice. If this pattern continues, the swelling turns in to a small nodule on each side. Because of the nodules, there is an area of gap in front and behind the nodules. Therefore, as the person tries to generate voice, there is a raspy and breathy quality to the their voice.

The best way to detect the presence of vocal nodules is by endoscopy. This could be done in an office setting using video endoscopic techniques.

If vocal nodules are identified, the patient is generally advised to go on voice rest. This includes minimal use of voice for a few weeks, coupled with absolute prohibition of yelling and whispering (whispering is generally as detrimental to the vocal cords as yelling). Most patients could also benefit from a few sessions of vocal therapy to learn proper voice techniques. Depending on the findings, some patients may benefit from anti-acid medicines to reduce any potential damage from gastric acid making the condition worse.

Occasionally, vocal nodules do not respond to medical therapy, and the patient may need to undergo endoscopic procedure in the operating room. Generally the nodules are decompressed or otherwise treated with the use of laser. This is an ambulatory procedure, and the patient is put on absolute voice rest for the following week.

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