VOCAL NODULE
• Synonyms: Singer’s nodule, Teacher’s nodule.
• frequently affects children and adults.
• In children it appears as spindle shaped thickenings of the edges of the vocal cords, whereas in adults they appear as more localised thickenings, varying from small points - nodules.
• These nodules typically appear at the junction of the anterior 1/3rd and posterior 2/3rd of the vocal cords.
• They appear almost aways symmetrically.
Pathophysiology:
• Are caused by a combination of overtaxing and incorrect use of the voice.
• This is also aggravated by the presence of infections in the para nasal sinuses, tonsils, and adenoids.
• Patients with habitual dysphonia frequently encounter this condition.
• This condition can be effectively prevented or cured by voice rest or by using the voice properly. Infact the nodules can appear and disappear in a matter of weeks. If the aggravating factors persist for a long time then these nodules become permanent.
Stages of vocal nodule formation:
Stage of transudation:
• Oedema occurs in the submucosal plane in this stage.
• This occur during the acute phase of the disorder.
• This stage is reversible in nature and may become normal on giving voice rest.
Stage of ingrowth of vessels:
• In this stage neovascularisation of the area occur.
• This phase is also reversible, but takes a long time to become normal.
Stage of fibrous organisation:
• In this stage the transudate in the submucosal area is replaced by fibrinous material.
• This stage is more or less resistant to conservative line of management.
[ ] These stages can be clearly observed by laryngoscopy under stroboscopic light.
[ ] Local oedematous swelling of recent onset vibrates in phase with the whole vocal fold, whereas an older and more fibrous swelling can impede the vibrations so much that only a part of the cord is seen to vibrate.
[ ] The improvement in the vibration pattern or signs of recovery are picked up early during stroboscopic examination.
Clinical features:
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Change in voice
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Fatiguability of voice
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Decreased pitch range
Management:
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Voice rest plays a major role in the management of vocal nodule. This may range from complete voice rest to partial rest.
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Speech therapy will help patients with habitual dysphonia from developing vocal nodule.
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If the vocal nodule bceome permanent then microlaryngeal removal is advised .