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What are Vocal Cord Nodules?
Interviewer: You might experience hoarseness or voice fatigue and just think, "Well, it's just a long day of talking." But sometimes those symptoms could point to something more, like vocal cord nodules.
Dr. Marisa Ryan is a voice and airway specialist from 91麻豆天美直播, who treats both adults and kids. And today we're going to explore what nodules are, what causes them, why people often delay treatment, and how to get the right diagnosis and care.
Dr. Ryan: They are small growths on the vocal cords, kind of like calluses. They're benign, meaning they're not cancerous, and they tend to result from overusing the voice.
Interviewer: Are most people kind of going to develop them if they use their voice a lot, or are there other factors that could lead to somebody getting nodules?
Dr. Ryan: There are definitely other factors because there are a lot of really talkative people who use their voices a lot who don't develop them. There tend to be different factors with how an individual uses their voice, or maybe other medical conditions that contribute to these calluses forming in the vocal folds.
Interviewer: And if you start getting them, what are some common symptoms people might experience?
Dr. Ryan: The most common one is hoarseness, which just means a difference in the way the voice sounds. Sometimes, when you have them, towards the end of the day or after using the voice a lot, your voice can get really tired, and that can come along with discomfort or feeling like something is in the throat when there really isn't anything there.
Who's Most at Risk for Developing Nodules?
Interviewer: How do vocal nodules develop, then?
Dr. Ryan: They develop essentially the same way calluses might develop on your hands if you're repetitively using your hands to do gardening or lift weights, and you get kind of like rough areas on the palms of your hands.
The same thing can happen with your vocal folds, which are the same thing as vocal cords, as voice professionals usually say vocal folds, but it's the same as vocal cords. When there's ongoing trauma on the edge of the vocal cords, then these rough patches of skin on the vocal cords develop.
Interviewer: So this is repeated vocal strain. It's not just like one day I was at a concert, and I yelled really loud, and the next day I was kind of hoarse. I have to do that a lot, right?
Dr. Ryan: Right, right. Typically, vocal cord nodules develop over weeks or months, or years. If it's a one-off kind of thing from screaming, then it's probably something else, like a polyp or a hemorrhage, or swelling. The nodules definitely take time and repeated trauma to develop.
Interviewer: So I would imagine the people at risk, when we think of vocal cord nodules, we think of singers and maybe stage actors, people who really use their voice. Are there other people who are affected that we might not normally think of?
Dr. Ryan: Definitely. Teachers or anyone who's giving a lot of presentations or talking to a large group, particularly if they're not using microphones or voice amplifiers. Also, anyone who's just like really talkative and loquacious can just from normal everyday social use, talking to family and friends, can even develop them.
Interviewer: Right. How about like somebody that's at a loud work site, like a construction worker or a manager, who has to talk a lot over equipment and stuff? I'd imagine they'd be in danger too.
Dr. Ryan: Definitely. Yeah, definitely. Because when you have to strain your voice to project over background noise, even if it doesn't seem like a lot of background noise, lots of us work with a lot of background noise that we're constantly talking over, and that can definitely contribute.
Everyday Habits and Health Issues That Can Worsen Vocal Strain
Interviewer: Are there other contributing factors that somebody might want to keep in mind? So, I'm using my voice a lot. Maybe I'm using it louder than the average person would. If I'm doing some other things, am I more likely to get vocal cord nodules?
Dr. Ryan: Definitely. You know, anything that can like irritate or dry out the voice box or the vocal folds and therefore make it work less efficiently can contribute. And that's things like first- or secondhand tobacco smoke exposure, allergies, a lot of acid reflux, especially when it's coming up into the throat, and dehydration. And that can be because dry air, like we have here in Utah, not drinking enough fluids, or even a lot of medications, will dry out our throat.
Interviewer: What about heredity? Is heredity an issue in vocal cord nodules?
Dr. Ryan: Not anything clear-cut. I mean, they might run in families, but probably more because those families have a similar degree of talkativeness or underlying contributing medical conditions. There's not a specific gene that makes you have vocal cord nodules.
Why People Might Delay Treatment
Interviewer: Let's talk about somebody who's listening to this, and they're like, "Wow. Yeah, that sounds like it could be me." But they don't seek treatment. What would be some reasons why somebody might not seek treatment if they have nodules?
Dr. Ryan: I think a lot of people just think that it's something they have to live with, or that's just the way their voice is, and don't realize that it is very treatable when you have vocal cord nodules.
Also, there are other things that can cause your voice to be hoarse, which could potentially be more serious than nodules that you don't want to miss. But most people think it's more of affecting their quality of life, and maybe don't realize that it's important to seek treatment and get to the bottom of it.
Interviewer: Right. So some people might normalize those symptoms. Some people might not even be aware that that's what's going on, I suppose. Are there some people who actually fear treatment?
Dr. Ryan: Definitely. I think some people are concerned that there could be something more serious or untreatable, and therefore put off getting a diagnosis and getting treatment, when really the diagnosis and the treatment are pretty straightforward. Some people might know that, in order to be diagnosed with vocal cord nodules or another lesion in your vocal cords, you need to have a brief scope procedure. And I think some people are fearful of that. Although it's definitely feared and kind of made to be more scary than it actually is.
What Happens When Nodules Are Left Untreated
Interviewer: Right. Yeah. What are some consequences of delaying potential diagnosis and treatment if somebody does actually have those nodules?
Dr. Ryan: For the nodules, the longer you have them, the more significant and larger they can become, and then that can make treatment more difficult or more prolonged. Also, when you have the nodules, you tend to try to adapt the way you use your voice and your voice box, and those adaptations can kind of temporarily help you squeeze out a good voice and get through the day. But when you do those adaptive or maladaptive things with your vocal cords, it can actually make it harder to undo those maladaptive techniques and make it harder to treat the way we typically treat the nodules.
Interviewer: Kind of like if you injure a shoulder and you don't do anything about it, and then you start making adaptations on how you use your shoulder. Now, all of a sudden, you're causing issues to other parts of your body, kind of doing the same thing to your vocal cords, it sounds like, maybe.
Dr. Ryan: Exactly. Yep. Great analogy.
Interviewer: Yeah. Because you're using those other muscles in ways they were never intended.
Dr. Ryan: Precisely.
Interviewer: So we know that we don't want to delay it. And I mean, some of the other consequences, I'd imagine, are that you could actually start to lose your voice.
Dr. Ryan: Yep, definitely. Some people can get so severe that they can lose their voice towards the end of the day, or if they, on top of it, get sick with a cold or something, really have trouble with barely having a voice.
Interviewer: But just in day-to-day life, how important is somebody's voice?
Dr. Ryan: Definitely extremely important. It's how we communicate with friends and family, and even people who have professions where they don't consider themselves to need to talk a lot, you still need your voice to be able to communicate, at least to some degree, even if you're not a professional voice user.
Interviewer: Right. It's a way we can get work done. It's a way we can connect with other people. So I'd imagine not only just from a very practical standpoint, but from a mental health standpoint, losing your voice or not being able to communicate could be pretty bad.
Dr. Ryan: Definitely. Yeah. It can be very isolating not to be able to hold conversations and communicate with people.
Diagnosing Vocal Cord Nodules
Interviewer: All right. Let's talk about some diagnoses and treatment. You said the diagnosis is actually pretty straightforward. What does that look like?
Dr. Ryan: The main way that we diagnose it is by looking with either a small, flexible camera through the nose or a more rigid camera through the mouth. That's called laryngoscopy. And additionally, we do what we call stroboscopy, where we use a special type of light to look at the vocal folds to differentiate between different types of lesions. That procedure is very quick and straightforward. Most people, even young children, tolerate it really well in the clinic setting while awake. And the nice thing about it is that you pretty much immediately have a diagnosis at the conclusion of that procedure.
Treatments for Vocal Cord Nodules
Interviewer: So, if you do identify some vocal cord nodes, what do you do? What are some treatment approaches? And is there like something you start with and then build up to other stuff, or how does that look?
Dr. Ryan: Typically, the main things that we start with are looking at the rest of the patient's history, what other contributing medical conditions they might have, like heartburn or reflux or allergies, sinus issues, and focusing on optimizing the treatment and control of those. Even without those, we spend a lot of time talking about how one uses their voice and how to use it efficiently, and keep the vocal folds and the voice box well hydrated and functioning ideally.
And then, in addition to that, the main and most critical part of therapy for individuals with vocal cord nodules is doing voice therapy. And that's a special type of therapy done with a specialized speech-language pathologist who has additional training and focuses on treating voice problems. And that's really the mainstay of treatment, to get someone to use their voice in a way that allows the nodules to heal and go away on their own with time.
Interviewer: Am I to understand that if you have reflux or allergies, that can cause nodules as well?
Dr. Ryan: Not alone, in and of itself, but it can definitely contribute to nodules forming and being more difficult to go away with the typical voice therapy treatment. So it is really important to understand and address those underlying medical issues.
When Surgery Is (and Isn't) the Right Option
Interviewer: All right. So first, you look at some lifestyle stuff. Then you look at some therapy. I'm starting to draw more parallels between the body, right? Is there a point where they are actually removed by surgery, or is it just a matter of they just need to heal?
Dr. Ryan: It's optimal if you can manage and control the underlying voice use techniques and medical conditions that are contributing to them, and then allow them to heal on their own. In certain instances, when the medical and therapy treatment doesn't work, or if the nodules are really large or really making it so that a patient cannot perform their work obligations, then we do sometimes do a surgical removal, but that's definitely not the first line of treatment.
Part of that is because the lesions, like I said, are calluses, and when you remove them, it's hard not to leave somewhat of a raw, irritated surface that can then continue to cause voice issues And whenever you do a surgery to remove something anywhere, and the vocal cords are no different, there's always a chance of scar tissue developing, which can cause other voice issues. So it's much better with vocal cord nodules to manage them medically and with voice therapy than to jump right to surgery.
Prioritizing Vocal Health Can Improve Daily Life and Mental Well-being
Interviewer: And with that medical management, with using your voice correctly, going into therapy, is it just like a callus on the hand? Eventually, it goes away when you stop doing the thing that irritates it.
Dr. Ryan: Precisely. Exactly.
Interviewer: Oh, okay. So they will just go away. That's fantastic. All right. As we wrap this up, curious what your final thoughts are for somebody who's listening to this interview. What would you want them to take away?
Dr. Ryan: I think the main things are to think about your voice and your vocal health the same way you think about any other aspect of your health. And when you have an ongoing problem with it, definitely don't hesitate to seek help and see either an ear, nose, and throat specialist and/or a speech-language pathologist who specializes in the voice to get to the bottom of what the problem is.