Vocal Nodules

Question 1

vocal nodules

Answer 1

localized benign growths of the vfs typically occurring at the mid point of the vfs

Question 2

how common are vocal nodules?

Answer 2

most common, benign lesions of the larynx

Question 3

directly related to phono-trauma and more specifically…

Answer 3

hyperfunction

Question 4

life cycle of vocal nodules

Answer 4

• period of phono-trauma where vfs begin to change
• soft, red, pliable bumps
• if phono-trauma continues, these lumps will become fibrotic and tissue with begin to change
• nodules themselves will become firm, fibrous, and thick and take on a whitish appearance

Question 5

because they take a while to show up, they also…

Answer 5

take a while to go away

Question 6

the bigger the lesion gets…

Answer 6

the more pronounced the vfs symptoms will be

Question 7

at the soft edeminous stage, common for them to be…

Answer 7

unilateral

Question 8

but once it’s mature, it is most often…

Answer 8

bilateral and symmetrical

Question 9

vocal nodules can resolve without surgery

Answer 9

takes 2-3 months for recovery

Question 10

only getting closure at the point of the nodules

Answer 10

• posterior chink
• anterior chink
• close in an hourglass configuration
• mucous banding

Question 11

close in an hourglass configuration

Answer 11

• expect a lot of breathiness
• not trying to compensate

Question 12

mucous banding

Answer 12

• tells that the vf edges have been roughed up
• mucous has something to grab a hold of

Question 13

etiologies of vocal nodules

Answer 13

• anything that can cause chronic laryngitis
• personality plays a role
• inappropriate habitual pitch
• excessive laryngeal tension
• allergies
• thyroid imbalances
• excessive loud talking or screaming
• hard glottal attack
• smoking and drinking

Question 14

inappropriate habitual pitch

Answer 14

• use a pitch that is not what should be used
• could be too high or too low

Question 15

thyroid imbalances

Answer 15

first sign can be somebody’s voice

Question 16

perceptual signs

Answer 16

• dysphonia
• lots of throat clearning
• vocal fatigue
• white fibrotic midpoint of vfs

Question 17

perceptual sign: dysphonia

Answer 17

the larger the lesion, the worse the dysphonia becomes

Question 18

lots of throat clearing

Answer 18

biproduct of the nodules

Question 19

vocal fatigue

Answer 19

• talking becomes a more effortful, tiring experience as the day goes on
• quality of voice progressively deteriorates

Question 20

white fibrotic midpoint of vfs

Answer 20

want to see hourglass configuration

Question 21

voice therapy, primary and effective

Answer 21

• including more mature nodules
• but the person must stick with the plan
• the nodules get smaller, and the voice starts to bounce back

Question 22

therapy goals

Answer 22

• reduce size of lesion
• prevent recurrence

Question 23

plan of therapy for vocal nodules

Answer 23

• if person has any vocal abuses/misuses that might contribute, then put on reduction plan to eliminate
• establish an individual program of vocal hygiene
• vocal rest sometimes, depends on stage of nodules

Question 24

symptomatic vocal nodules

Answer 24

• what is the patient doing vocally that either caused or perpetuated the nodules
• how do we get rid of that
• reducing vocal loudness
• look at breath management
• look at what’s going on, and then devise a treatment plan

Question 25

medical management

Answer 25

• only see surgery when nodule persists
• can cross the point where spontaneous healing is no longer possible

Question 26

personality does play a factor

Answer 26

• studies have shown
• particularly for women
• tend to be type A, impulsive, oversharer, talker, vocal exhibitionist
• behaviors are an outgrowth of the personality