What Are Vocal Cord Nodules?

The vocal cord nodule, also known as the singer's nodule or the teacher's nodule, is a special type of chronic laryngitis that occurs in children and is called a nodule. It is formed by inflammatory lesions. The main clinical symptom is hoarseness. Laryngoscopy can be used for clinical diagnosis. Treatment includes proper vocal cord rest, corrective vocalization methods, and surgical treatment.

Basic Information

nickname: Singer's summary, teacher's summary
English name: vocalnodule
Visiting department: ENT

Multiple groups: Teachers, actors, singers, etc.
Common causes: Excessive or improper use of voice, upper respiratory tract infection, exposure to irritant pathogens, endocrine disorders, etc.
Common symptoms: Hoarseness, accompanied by delay in pronunciation, tone change

Causes of vocal nodules

Various causes of chronic laryngitis can cause vocal nodules. The most common are:

1. Excessive or improper use

It is common in professional speakers such as teachers, actors, and singers. Long-term continuous high-speaking, high-pitched or long-time singing can lead to vocal nodules.

2. Upper respiratory tract infection

Colds, acute and chronic laryngitis, rhinitis, sinusitis, pharyngitis, lungs, trachea, bronchitis, etc. can all become the cause of the disease. If excessive sound is used in the presence of upper respiratory tract inflammation, vocal nodules are more likely to occur.

Nasal, sinus, and pharyngeal infections can be caused by inflammation that directly spreads downward, or inflammatory secretions flowing into the throat, causing obstacles in vocal resonance, which can cause improper vocalization and increase laryngeal muscle fatigue, leading to this disease. When the lung, trachea, or bronchus is infected, the cough can cause the inflammatory secretions produced by it to contact the larynx for a long time, and the disease can also be secondary.
3. Endocrine disorders

Vocal nodules have gender differences in incidence between children and adults, and it is rare for people over 50 years of age to have this disease. Therefore, some scholars believe that endocrine factors may have some relationship with vocal nodules.
4.Laryngopharyngeal reflux

Laryngo-pharyngeal reflux disease has received more and more attention in recent years, and research on this disease has continued to deepen. Some scholars believe that chronic inflammation caused by gastric content reflux stimulating the larynx mucosa is also one of the causes of vocal nodules.

Clinical manifestations of vocal nodules

Multiple groups

Most patients with vocal nodules are hypervoicers, and both children and adults can develop the disease. Among children, boys are more common than girls, but they tend to disappear by their puberty; in adult cases, the incidence is higher in women than in men, and it is rare in patients over 50 years of age.

2. Symptoms of the disease

The main symptom is hoarseness. Early stage is lighter, sound is slightly rough or almost normal, mainly due to vocalization, fatigue, frequent use, sometimes good and bad, intermittent hoarseness; often hoarseness when treble, accompanied by delay, tone Changes, etc .; Some patients may not see obvious sound changes in daily conversation, but when singing, they may have more obvious manifestations such as narrowing of the sound range and limited vocalization. The condition continues to develop, with aggravating hoarseness, which can progress from intermittent to persistent, and also occurs when making low sounds. Hissing prevents actors from singing or teachers from giving lectures. The degree of hoarseness is related to the size and location of the vocal nodules.

Many patients have a history of upper respiratory tract infection before the onset of the disease, followed by a vocal nodule, so that hoarseness cannot be completely relieved after the infection is cured. The whole process may make patients mistakenly believe that hoarseness is caused by infection, and ignore the adverse effects on the vocal cords caused by excessive daily use and improper use of voice.

Vocal Cord Summary

Laryngoscopy (indirect laryngoscope, direct laryngoscope, fiber laryngoscope, electronic laryngoscope, stroboscopic laryngoscope, etc.): diagnosis can be made through various laryngoscopes combined with clinical symptoms.

A typical vocal nodule is a symmetrical nodular bulge at the front 1/3 junction of the bilateral vocal cords. Early in the vocal cords, the marginal anterior-middle 1/3 junction was seen. Secretions were attached during vocalization. When the vocal cords were abducted, the secretions straddled the glottis. Thereafter, the mucous membrane at the vocal cord was edema, soft and reddish. In the later period, it gradually turned into a small gray-white uplift, with a smooth surface and a solid feel. It was about half a meter in size and became a clear nodule. The nodule generally occurs bilaterally symmetrically, with occasionally one side being larger, the other side being smaller or only one side visible. The vocal nodules can be localized small protrusions or broad-based shuttle-shaped thickened. The former is more common in singers who mispronounced it, and the latter is more common in other professionals who use excessive voice. The nodules on both sides lean against each other when making the sound, so that the glottis cannot be completely closed, and it is in the shape of an "hourglass".

Those who are not satisfied with the indirect laryngoscope observation can use direct laryngoscope, fiber laryngoscope, electronic laryngoscope, stroboscopic laryngoscope, etc. Among them, stroboscopic laryngoscope can observe both vocal morphology and vocal cord movement. In addition, various vocal acoustic assessments and aerodynamic assessments can be performed to understand the extent to which the vocal cords and airflow through the glottis are affected by lesions during vocalization.

Vocal nodule diagnosis

Mainly based on clinical symptoms, that is, a long history of hoarseness, combined with laryngoscopy, clinical diagnosis can be made.

Differential diagnosis of vocal nodules

Vocal cord polyp

The distinction between vocal cord polyps and vocal cord nodules is mainly based on clinical macroscopic morphology. Most of them are soft, translucent new creatures at the junction of the front middle 1/3 of the vocal cord edge, white or pink, and the surface is smooth.

2. Vocal cord cyst

Including retention cysts and epidermoid cysts. The cysts are hemispherical, with a smooth surface, grayish white, yellowish, or reddish, and the cyst wall is generally thin. It can be fluctuated when touched, and can be distinguished by stroboscopic laryngoscopy.

3. Laryngeal papilloma

It is the most common benign tumor of the larynx and is generally considered to be caused by a viral infection. It can be single or multiple. The mass was pale, reddish or dark red, the surface was often mulberry-like or only rough and uneven like villi, and the pedicel often moved up and down with respiratory airflow, which can be identified by pathological examination.

4. Laryngeal tuberculosis

Mostly located in the back of the larynx, it is characterized by pale larynx mucosa, edema, and multiple superficial ulcers, such as worm-like. Congestion and thickening of the vocal cords may also occur on one side. It can be accompanied by systemic symptoms such as low fever and cough. Chest radiographs, tuberculin experiments, and sputum culture can help identify them.

5. Laryngeal cancer (glottic type)

Occurs in older men, usually with a long history of smoking, and hoarseness is progressively worse. Laryngoscopy shows cauliflower-like or nodular masses located in the vocal cords. The surface is not smooth or rough. It can be attached with pseudo-membrane or ulcers. The texture is brittle and easy to appear. Soundtrack fixed. In the later stage, dyspnea, metastatic cervical lymphadenopathy may occur, and systemic symptoms such as cachexia may occur at the end.

Vocal nodules treatment

Includes proper vocal cord rest, corrects bad vocal habits, medication and surgical treatment.

General treatment

Vocal cord rest: early vocal cord summary, after proper vocal cord rest, often smaller or disappear. Children's vocal nodules may also disappear on their own during puberty. Even though the larger summary can't disappear, the sound can be improved. If the vocal cord rest has been 2 to 3 weeks, and the summary has not significantly decreased, other treatment measures should be taken, because the vocal cord muscles are not active for a long time, but it is not good for vocalization.

Vocal training: Patients with vocal cord summary often disappear on their own after a period of vocal training. Vocal training can improve the efficiency of pronunciation by adjusting breathing airflow, changing attack habits, and better use of resonance chambers, coordinating the functions of various organs such as breathing, vibration, resonance, and bite to change the original wrong habits of inappropriate sounds , Relieve the tension in the throat, and finally achieve scientific pronunciation.

In addition, smoking, drinking and spicy and irritating foods should be restricted, avoiding coffee, strong tea, etc., and avoiding exposure to irritating gases, dust and other pathogenic factors.

2. Drug treatment

Local treatment can be given physical therapy and nebulized inhalation treatment.

Acid-suppressing drug treatment: inhibit gastric acid secretion, reduce chronic inflammation of throat mucosa caused by laryngo-pharyngeal reflux, can treat and prevent vocal nodules.

3. Surgical treatment

Vocal nodule resection: For larger vocal nodules, those who simply do not take a break, use medication or voice training may consider surgical resection. There are many surgical methods, depending on the size and location of the nodule. Smaller nodules can be removed under surface anesthesia with fiber laryngoscope or electronic laryngoscope, but with the development of laryngeal microsurgery technology, most patients with vocal nodules undergo general anesthesia under the support of laryngoscope under microscope Laser resection and micro-flap technique of micro instruments. At present, the technique of intra-laryngeal intra-laryngeal surgery is becoming more and more mature, and various types of laser, micro-instrument, plasma knife and other resection methods are changing with each passing day.

Vocal nodule prognosis

If, after improvement, the patient is still exposed to risk factors such as excessive use, improper use, and smoking, the vocal nodules may reappear. After surgery, we must continue to avoid and treat possible pathogenic factors. If possible, we must conduct vocal training to change bad vocal habits and prevent recurrence of vocal nodules.

Vocal nodule prevention

The vocal cord rest and vocal training can prevent the disease to a certain extent. At the same time, smoking, drinking, spicy food and other irritating pathogenic factors should be avoided. Attention should also be paid to preventing upper respiratory infections such as colds and reducing the causes of vocal nodules.

References

1. Huang Xuanzhao, Wang Jibao, editor of Kong Weijia. Practical Otorhinolaryngology Head and Neck Surgery 2nd Edition. Beijing: People's Medical Publishing House, 2007: 434-445.

2. Edited by Tian Yongliang. Otolaryngology Head and Neck Surgery 7th Edition. Beijing: People's Medical Publishing House, 2008: 192-195.

3.CharlesWCummings. Otolaryngology-HeadandNeckSurgery3rdedition: Mosby-YearBook, 1998: 2096-2129.

4. Yu Ping, editor of Wang Rongguang. Voice disorders and voice surgery. Beijing: People's Military Medical Publishing House, 2009: 97-98.