Vocal cords, also known as vocal folds are a structure in the larynx cavity, which creates sound by vibrating in different patterns, extends horizontally front to rear in the cartilage structure and consists of two tight mucous membranes. The surfaces of the vocal cords are flat; when they are closed, their free surfaces correspond and a complete closure is ensured. The size of the vocal cords determines the pitch, namely, the volume of voice. They are shorter and thinner in women and children. Therefore, women and children have more high-pitched voice.
Voice is the most important communication tool that must be carefully protected against any distortion or injury. Because the quality of sound produced is related to the healthy and synchronized movement of the vocal cords. Excessive and improper use of the voice which causes excessive friction when the vocal cords collide causes benign lesions, irritation and inflammation that do not cause cancer on the vocal cords over time. Normally, the vocal cords vibrate 100-150 times a second in men, 200-250 times a second in women, and 400 times a second in babies. Thus, the vocal cords are the tissues most exposed to wear on the body.
Vocal Cord Nodule refers to benign lesions that usually occur in the middle and anterior part of the free surface where the vocal cords come into contact with each other in consequence of long-term use of the sound at the wrong intensity and pitch or excessive use. The microscopic view of the vocal cord nodules looks like callus; they are sometimes associated with abnormal blood vessels. Since the vocal cord nodules are usually formed by collision of both vocal cords, there are usually two vocal cord nodules and they are located opposite each other. They are also called Singer’s Nodule or Singer’s Node.
Factors such as intense smoked environment, reflux problem, working in excessively noisy environments requiring loud speech, chronic alcohol use, sinusitis, allergies, thyroid gland enlargement, and drug side effects facilitate the formation of vocal cord nodules.
It is more common in vocal artists who are professional voice users, teachers, announcers and call center workers, or people who speak too much by nature or due to their environment. Although it is seen in men, women and children, it is more common in women between the ages of 20 and 50 and children who talk loudly due to the structure of the larynx.
Though the symptoms of vocal cord nodules vary from person to person, the vocal cord nodule should be suspected when one or more of the following symptoms are seen together or if hoarseness lasts for more than two weeks:
Voice changes such as muffled, gravelly, tired, misty, cracked or low-pitched (hoarse) voice,
Unrest and tiredness in throat,
Difficulty in speaking and swallowing,
Inability of singers to get high octave or loss of their voice completely.
To understand whether the symptoms are an indicator of vocal cord nodule, in-depth examination should be carried out by an ear, nose and throat specialist. Vocal cords are observed first in the examination of vocal problems. In line with the technological developments used in the visualization tools, we can have precise results now. The most commonly used imaging tools are videolaryngostroboscopy (VLS), which is a stroboscopic visualization system that can take 30 frames per second, and High Speed Digital Visualization (HSDV), which can take 2000 frames per second. While VLS is mostly used for clinical purposes, HSDV is used more in research laboratories due to its expensiveness and inability to use flexible endoscopes. The problem is determined based on the related specialist’s observations that are supported with objective sound analysis and the diagnosis is made, then the appropriate treatment is decided.
Medical therapy is administered primarily for the treatment of nodules caused by medical problems such as reflux, sinusitis, allergies, and thyroid gland enlargement. Voice therapy or surgical intervention method is used for the treatment of vocal cord nodules that are not caused by medical problems:
Voice Therapy: This therapy is administered to make the habit of using voice at the right intensity and pitch and to prevent excessive pressure to the vocal cords. In voice therapy, the patients are primarily informed about respiratory and articulatory organs, sound formation, protection of the voice mechanism and hygiene. Then, they are asked to do some exercises for the use of breath and voice. This is applied for about 8-10 sessions over a period of 1-2 months.
Surgery of Vocal Cord Nodule: Despite the administered voice therapy and vocal cord rest, the non-healing voice cord nodules are removed by a surgical intervention. This intervention is called Vocal Cord Nodule Surgery.
After a vocal cord nodule is diagnosed, if the patient does not respond to voice rest, medication and voice therapy, a surgical intervention is decided. Endoscopic techniques, which are called Laser Surgery or Phonomicrosurgery, Microlaryngoscopy, which do not involve any excision procedure are generally used:
Phonomicrosurgery/Microlaryngoscopy: This is a surgical intervention which is administered to cut and remove the nodule when the vocal cord formation is big or it is in an area difficult to reach. It is performed under general anesthesia. The vocal cords are reached through the mouth and the nodule is removed without harming the surrounding healthy tissue by use of a laryngoscope and other endoscopic equipment that provide a magnified high quality image. The operation takes approximately 30-60 minutes. Since no stitch is necessary, the patients can be discharged on the same day. There is no limitation for eating and drinking activities, yet patients are not allowed to whisper or speak in a normal voice for a week so as to rest their voice. They may complain mild sore throat and difficulty in swallowing for maximum one day. In case of numbness in the tongue and inability to taste caused by the compression of the tongue during the operation, these complaints will automatically end within a few weeks.
Since the reason for voice cord nodule formation is the wrong use of voice, nodule may reappear if the voice is used incorrectly after the surgery. Thus, it is undoubtedly necessary to receive a voice therapy after healing in order to learn and use the voice correctly.
This surgery does not have a severe risk. If the patients do not follow post-operation recommendations and instructions specified by the doctor, even rarely, they may experience loss of voice, bleeding, permanent voice impairment due to vocal cord trauma, and vocal cord paralysis.
If you also have problems such as hoarseness, changes in voice, discomfort and pain in the throat for more than ten days, you can reach us via our contact information and get more information and receive treatment in our health center that uses state-of-the-art technology tools and equipment for diagnosis and treatment of vocal cord disorders and priorities your special demands and needs.