Vocal nodule – Etiology, Pathogenesis, Clinical features and Management

• Vocal nodules are the a type of non neoplastic benign lesions of vocal cords
• They are nodular lesions located in the free edge of the vocal cords that arises as a result of voice abuse

Etiology:

• Voice abuse is the most important etiological factor
  • Speaking in low tones or high intensity for long periods to time
• It is seen in people who tend to use their voice a lot like singers, singers and children
• Hence it is also known by the following alternate names:
  • Singer’s nodules
  • Speaker’s nodules
  • Minister’s nodules
  • Teacher’s nodules
  • Screamer’s nodules

Pathogenesis:

• Voice abuse initially results in oedema and haemorrhage in the submucosal space
• Later it undergoes hyalinisation and fibrosis
• The overlying epithelium undergoes hyperplasia and forms a nodule

Clinical features:

• Hoarseness of voice is the main complaint
• Voice fatigue
• Pain in neck

Laryngoscopy findings:

• Bilaterally symmetrical nodules on both vocal cords in their free border
• Location – At the junction of anterior one third and posterior two third (this is the area which undergoes maximum vibration during speech)
• Size – Pin head sized to half the size of a small pea
• Appearance – Initially appear red and oedematous, later changing to grey and fibrosed

Management:

• Voice rest is the most important intervention
• The patient should be advised on how to use their voice properly
• Early lesions, especially in children heal well with voice rest alone
• Late lesions, especially in adults may require excision under operating microscope
• Speech therapy is essential to prevent recurrence