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

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