I often find that many patients with hoarseness are anxious because they have vocal cord nodules and are eager to have immediate surgery to remove them and restore their voices. Do all vocal cord nodules require surgery? Is surgical removal a once-and-for-all solution?
First of all, we need to know why we have vocal fold nodules. Vocal fold nodules are mainly caused by excessive or improper use of voice. Patients often use a hard rising voice, too high or low pitch, etc. Most patients also have the experience or habit of shouting, screaming, speaking for too long or using their voice for too long in a noisy environment. Teachers, ticket sellers, actors, lawyers and other professional voice users are the high-risk groups prone to dysarthria. In addition, many children, especially boys, are active and like to shout and use their voices uncontrollably. Other related factors include (1) allergy, (2) chronic cough, (3) throat reflux, (4) endocrine disorders, (5) upper respiratory tract infection, (6) vocal cord dehydration and excessive sticky secretions, (7) ear and hearing problems, (8) other congenital diseases, etc. Long Ping, Department of Otolaryngology and Head and Neck Surgery, The First Affiliated Hospital of Nanchang University
Most patients with vocal cord nodules have symptoms such as hoarseness, breath sounds, change in range and articulation fatigue. A small number of vocal cord nodules do not interfere with articulation, and patients may have no obvious symptoms. Hoarseness is often the first and most important symptom. Patients may not show any signs of dysphonia in the morning, but with excessive use of voice, hoarseness will gradually increase. The degree of dysphonia is also related to the location, type and size of the vocal cord nodules, and the more advanced the nodules are, the more pronounced the hoarseness is. In the early stage, the hoarseness is intermittent and can be relieved after pronunciation rest. In the later stage, when the vocal fold nodules increase in size, it can cause poor vocal fold closure, presenting a breath sound and the patient will also have periodic loss of voice.
When you go to the hospital, you need to perform an electronic laryngoscopy first. Under the electronic laryngoscope, the vocal fold nodules appear as limited mucosal swelling or nodule-like protrusion at the junction of the front middle 1/3 of the free edge of the vocal folds, with bilateral symmetry (see picture), and the vocal folds do not close completely in an hourglass-like manner during pronunciation. Vocal fold nodules can be further divided into: (1) soft nodules: also known as early nodules, limited inflammatory changes caused by improper pronunciation, with slightly red surface and soft texture, accompanied by edema; (2) hard nodules: also known as chronic nodules, mostly seen in professional vocal users with improper use of voice, with white, thick lesions, obvious fibrosis, and mildly asymmetric mucosal waves in hard nodules. This physiological swelling is usually classified as normal and disappears after 24-48 hours of rest.
Don’t panic if you have vocal cord nodules. Most vocal cord nodules do not require surgery, especially for children. Patients with vocal cord nodules prefer articulation therapy, which can shrink the nodules, make them disappear or make the symptoms disappear through articulation therapy. Even for the nodules that eventually need to be removed surgically, pronunciation therapy before and after the surgery is necessary to prevent recurrence. The cooperation of psychologists and speech pathologists should also be sought during the treatment process to obtain the best results. When conservative treatment is not effective and the lesion is significantly larger, surgical treatment should be performed.