Vocal cord nodules
Synonyms in a broader sense
Medical: phonation nodules
Corns "of the vocal folds, vocal cord nodules
definition
Vocal cord nodules (phonation nodules or vocal cord nodules) are counted among the benign tumors of the larynx. One speaks of a "tumor on the vocal folds", but it is not a spreading (metastatic) cancer (larynx cancer).
Vocal cord nodules can appear at any age and cause a significant reduction in our voice and speech quality. The hoarseness and harsh voice are the main symptoms. Vocal cord nodules can be treated well by sparing the voice or by small surgical interventions.
causes
In general, overuse of the vocal cords is the cause of the development of nodules.
This overuse can have different reasons. People who make heavy demands on their voices at work, such as singers or teachers, are particularly affected.
Why some people are more prone to developing vocal nodules than others is not yet fully understood.
Incorrect vocal technique will be the causative factor in some cases.Another group of people in which vocal nodules occur more frequently are babies who cry a lot (“cot babies”).
In these children, the cause of all the crying should be found if possible in order to prevent the formation of the nodules. In principle, the overloading of the vocal cords creates water retention, which leads to so-called soft nodules. These can usually recede by sparing the voice. With continuous stress on the vocal cords, so-called hard nodules form on the bottom of these soft nodules, which must be surgically removed.
Since the vocal cords no longer fit together perfectly due to the nodules, the familiar hoarse voice is created when speaking.
Precancerous lesions
At a Precancerous disease it is a change in the tissue, for example in the form of a Mucosal overgrowth (polyp) can show. It represented a possible preliminary stage of a malignant tumor or can even be in the transition to a malignant cancer.
However, the vocal cord nodules are one benign growth and not a precancerous condition, as the nodules are caused by overuse of the vocal folds. The nodules often recede on their own after successful therapy.
To be distinguished from the harmless vocal cord nodules is the so-called Larynx papillomatosis, in which mucosal nodules can form in the entire larynx, including on the vocal folds. These are mostly caused by a Infection with the Human Papilloma Virus (HPV)which can usually be transmitted through oral intercourse. These represent a precancerous condition and can therefore turn into a malignant one Throat cancer pass over.
Emergence
Vocal cord nodules are mainly found in people who use their voice continuously and intensively.
These include certain professional groups such as:
- Singer
- Teacher
- and some politicians.
Some develop vocal nodules even though they are not putting undue strain on their voice. This is probably a wrong vocal technique.
Constantly conscious speaking up or imitating a wide variety of sounds can also lead to nodules on the vocal folds.
Read about this too Laryngeal papillomatosis
Symptoms
When vocal cord nodules are present, it is difficult to speak loudly and forcefully.
The body defends itself against voice overload. The voice becomes rougher and hoarse and you have the feeling that you have to keep clearing your throat to get a clear voice again.
But clearing your throat doesn't bring any relief. Hoarseness and rough voice only disappear after adequate therapy.
Read more on the topic: Symptoms of vocal cord inflammation
The Main symptom of vocal cord nodules is a so-called Dysphonia (Voice disorder). How pronounced the disorder is can vary greatly from person to person.
In general, however, the number and size of the nodules and the quality of the voice correlate with one another.
The change in the voice can be described with different qualities. Usually adjectives such as hoarse, rough, occupied or breathy are used. The feeling of having to clear one's throat is also typical in the presence of Vocal cord nodules. However, clearing your throat never actually improves your voice. In some cases, vocal cord nodules can even prevent those affected from speaking for a period of time.
The voice disorder associated with the vocal cord nodules is usually perceived as very annoying by those affected. If the nodules have not existed for a long time, the symptoms recede after some time while the voice is gentle. However, the recurrence of the disorder and the nodules are common in people who have been affected, which is why general voice protection can be advised.
diagnosis
If you have been hoarseness and your voice is restricted for a long time, your family doctor will refer you to an ENT doctor. With a Laryngoscopy he will be able to observe the glottis closely.
Small changes such as nodules are quickly discovered and identified by an experienced ENT doctor. Of course, another finding can be concealed behind a swelling or a nodule. The examining doctor then decides on further examinations.
therapy
If it is just a small nodule that has only recently been causing symptoms such as hoarseness and harsh voice, the ENT specialist will first advise you Voice protection guess. In some professions, such as that of a teacher, there is a lot of talking that cannot be avoided.
In this case the specialist will issue you a certificate. In the so-called screaming children, further diagnostic measures may be appropriate to find out the cause of the excessive screaming.
Pediatricians, psychologists and neurologists can be typical points of contact for diagnosis of screaming children.
If there is no improvement even after voice protection, the doctor will discuss the possibility of a possible change of occupation with you and explain the benefits of long-term voice protection to you.
For larger, hard nodules that block the voice almost completely, there's the option of one surgical ablation. This is a small intervention that usually does not lead to more serious complications. Nevertheless, a longer period of voice protection must be planned after the operation.
Vocal exercises
In the acute phase the voice should do the best it can spared become.
Voice exercises should still be used for a new one Avoid overloading the vocal folds. The exercises should also Every day be repeated.
The patient can begin with an exercise that strengthens the diaphragm, as the diaphragm is important for a strong voice and can thus relieve the vocal cords. The exercise takes place in a straight sitting position. The sounds "Psst" and "Ksch" are spoken alternately. Good body tension and posture should be ensured during the exercise.
Another voice exercise is, for example, the so-called "Chewing sums". The patient imitates a chewing movement with an open mouth and lets the sounds "mmmh" and "mjam" sound. Singing “nnn” and “mmm” in a melody (for example a scale) also trains the vocal cords. It should be ensured that no notes that are too low or too high be sung, otherwise the vocal cords will again be stressed too much. There are many other exercises that should be discussed individually with a speech therapist.
Speech therapy
Speech therapy (speech and speech therapy) is an important means of treating the vocal cord nodules and symptoms. Patients should definitely seek professional therapy. Especially if - as is often the case - a job is carried out in which a lot is spoken (e.g. teacher). In the speech therapy sessions, breathing exercises and finding the correct voice pitch are trained with the patient. These exercises can then be performed daily at home by the patient.
If speech therapy does not show any success after a few weeks, however, surgical removal of the nodules should be considered.
Operative therapy
A surgical removal of the vocal cord nodules is not necessary in most cases.
After taking care of the vocal cords, the nodules usually recede by themselves, whereby the disturbing symptoms also decrease.
However, surgery to remove the nodules may only bring relief. This is especially the case if the vocal cords are not spared after the initial nodule formation. In these cases it can happen that hard knots form on the so-called soft knots that have already formed.
These can then only be removed with an operation. Specialists in the field of these operations are specialists in ear, nose and throat medicine. The operation itself is a minor procedure and is usually not associated with serious complications.
However, since every operation brings with it a certain residual risk, it is advisable to protect the voice immediately after the formation of nodules in order to avoid the operation. It should also be mentioned that despite an operation, if the vocal cords are further overloaded, nodules can still develop. At the beginning of the disease, it is preferable to protect the vocal cords and to have speech therapy with a speech therapist during an operation.
Vocal cord nodules in children
Also Children and babies can develop such nodules through excessive crying (so-called "screaming children"). Often this fails Hoarseness of children on.
In children who speaking excessively loudly and a lot or scream, vocal cord nodules can also occur. That is why these are also referred to as "screaming knots" in children. As with adults, symptoms such as Hoarseness, rough voice and constant clearing of throat on. There is also one Hearing loss could be behind the child's speaking loudly, a doctor should examine their hearing.
It is important that the child early therapy begins so that the vocal folds are quickly spared. The child should learn to use the voice calmly. Since children often want to make themselves heard by speaking out loud, parents can also encourage therapy by ensuring that the child is quiet. In most cases disappear then the vocal cord nodules until puberty again.
