Vocal Nodules
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| Example of advanced vocal cord nodules. |
The term nodule is used frequently when referring to a lesion (swelling or growth) on the vocal cords. Many patients are diagnosed with “nodules” on their vocal cords, and are referred to speech therapists to resolve their condition. In fact, there are many different types of lesions that can appear similar to vocal cord nodules, and the treatment varies depending on the root cause of the problem.
Vocal cord nodules are a specifically defined entity that results from a relatively well-defined set of causes, and which have well-defined treatment guidelines. True nodules arise due to vocal abuse behavior, combined with several other factors, including, most importantly, laryngopharyngeal reflux disease. Nodules created in this manner are always bilateral (directly apposing), and appear at the junction of the anterior 1/3 and posterior 2/3 of the vocal cords. This area is most susceptible because it is the point on the vocal cords that takes the brunt of the vocally abusive behavior.
In order to distinguish true nodules from other lesions that may look similar, special examination techniques may be needed to more closely examine the vocal cords. These tests may include rigid laryngoscopy or flexible laryngoscopy with or without stroboscopy. These tests provide better images and give more information that may be helpful in arriving at the proper diagnosis.
Nodules may vary in severity. Early nodule formation may be referred to as “prenodules.” These “prenodules” are soft, and easily resolved with minimal intervention. More advanced forms of nodules are harder, almost callous-like. These are more difficult to resolve, and may require surgical intervention.
Once a diagnosis of vocal cord nodules is reached, the treatment regimen can be initiated. Generally, the treatment of choice for these lesions is speech therapy. Often this is combined with other treatments aimed at helping to resolve some of the other issues that may lead to nodule formation. As a whole, this “medical” regimen is highly effective in resolving the majority of nodules. Obviously, the less advanced the nodules, the easier they are to cure. Occasionally, however, patients may need surgery to remove advanced lesions. This does not, however, preclude adjunctive medical therapy. If lesions are removed, and the underlying causes are not addressed, the patient is at an increased risk not only of a poor voice outcome, but of a possible recurrence of the nodules.
