How nodules form
When speaking, the vocal folds close and vibrate hundreds of times per second. If a person speaks loudly, for a long time, against a background of noise or at an uncomfortable pitch, the load in the central part of the folds becomes excessive. First, swelling of the mucous membrane occurs, then a dense thickening forms at the site of maximum impact. The nodules are almost always paired and located symmetrically. Because of them, the folds cannot close completely, a gap remains between them, the air passes through with noise, and the voice sounds hoarse and gets tired.
- Excessive load on fold edges
- First swelling, then dense thickening
- The nodules are usually symmetrical and paired
- Incomplete closure of folds
- Hoarseness and fatigue of the voice
Causes and risk factors
The main factor is incorrect and excessive vocal load: shouting, talking in a noisy environment, trying to shout over a class or hall, prolonged speech without pauses. The situation is aggravated by smoking, dry and dusty air, lack of drinking, working with a chronically stuffy nose when a person breathes through the mouth. The reflux of acidic contents from the stomach plays a significant role: it maintains irritation of the larynx, especially in the morning. In children, nodules are almost always associated with crying and often improve with age with behavioral modification.
- Professional voice loads
- Screaming and talking in noise
- Smoking, including passive smoking
- Dry air and lack of fluids
- Chronic runny nose and mouth breathing
- Gastroesophageal reflux
- Incorrect speaking and singing technique
Symptoms
The main complaint is persistent hoarseness, which does not go away after resting for a couple of days, as with a common cold. The voice loses its sonority, becomes lower and muffled, and becomes aspirated. The person notes that towards the end of the working day it becomes more and more difficult to speak, one has to strain, there is a feeling of a lump or dryness in the throat, and sometimes coughing. Singers are characterized by loss of high notes and difficulty singing quietly. There is usually no pain; its presence requires special attention from a doctor.
- Persistent hoarseness for more than 2–3 weeks
- The voice settles in the evening
- Aspiration and loss of voicing
- Rapid voice fatigue
- Feeling of a lump and dryness in the throat
- Loss of upper range in singers
Diagnostics
An examination of the larynx is mandatory: the ENT doctor examines the folds using a mirror or endoscope. Video stroboscopy provides more accurate information, allowing you to see how the folds fluctuate and distinguish nodules from a polyp, cyst or edema. The doctor must rule out other causes of hoarseness, primarily laryngeal tumors, especially in older people who smoke. Additionally, the condition of the nose and pharynx is assessed, and if reflux is suspected, they are referred to a gastroenterologist. Clarifying the diagnosis is important because the tactics for nodules, polyps and cysts differ.
- Examination by an ENT doctor, laryngoscopy
- Video stroboscopy if possible
- Assessment of speech technique and vocal load
- Rule out laryngeal tumor
- Examination of the nose and throat
- Reflux testing for morning hoarseness
Treatment
The first and most important thing is the voice mode: do not whisper, do not shout, speak more quietly and briefly, take pauses, drink water in small sips. Whispering is especially harmful because it strains the folds more than normal speech. The main method of treatment is voice therapy with a phoniatrist or phonopedist, where a person learns proper breathing, a soft attack of sound and economical speech; With conscientious practice, the nodules often decrease or disappear. At the same time, they eliminate irritants: quit smoking, humidify the air, treat runny nose and reflux. Surgical removal is discussed only if conservative treatment is ineffective and is always combined with subsequent treatments, otherwise the nodules return.
- Voice rest in the acute period, refusal to whisper
- Classes with a phoniatrist or phonopedist
- Teaching correct speech and breathing techniques
- Humidify the air and drink enough
- Quitting smoking
- Treatment of runny nose and reflux
- Microsurgical removal if therapy is ineffective
- Mandatory voice rehabilitation after surgery
