Vocal fold nodules

Vocal voice nodule
Classification and external resources
Specialty	otolaryngology
ICD-10	J38.2
ICD-9-CM	478.5
DiseasesDB	29628
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Vocal fold nodules are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds. Although diagnosis involves a physical examination of the head and neck, as well as perceptual voice measures, visualization of the vocal nodules via laryngeal endoscopy remains the primary diagnostic method. Vocal fold nodules interfere with the vibratory characteristics of the vocal folds by increasing the mass of the vocal folds and changing the configuration of the vocal fold closure pattern. Due to these changes, the quality of the voice may be affected. As such, the major perceptual signs of vocal fold nodules include vocal hoarseness and breathiness. Other common symptoms include vocal fatigue, soreness or pain lateral to the larynx, and reduced frequency and intensity range. Airflow levels during speech may also be increased. Vocal fold nodules are thought to be the result of vocal fold tissue trauma caused by excessive mechanical stress, including repeated or chronic vocal overuse, abuse, or misuse. Predisposing factors include profession, gender, dehydration, respiratory infection, and other inflammatory factors.

For professional voice users as well as individuals who frequently experience hoarseness, vocal hygiene practices are recommended for the prevention of vocal fold nodules and other voice disorders. Vocal hygiene practices include three components: regulating the quantity and quality of voice use, improving vocal fold hydration, and reducing behaviours that jeopardize vocal health. About 10% of nodules resolve on their own, which is more likely if they are smaller and the onset more recent. Treatment of vocal fold nodules usually involves behavioural intervention therapy administered by a speech-language pathologist. In severe cases, surgery to remove the lesions is recommended for best prognosis. Vocal fold nodules occur more frequently in females. In children, they are more common in males; in adulthood, they are more common in females.

One of the major perceptual signs of vocal fold nodules is a change in the quality of the voice. The voice may be perceived as hoarse, due to aperiodic vibrations of the vocal folds, and may also be perceived as breathy, due to an incomplete closure of the vocal folds upon phonation. The degree of hoarseness and breathiness perceived may vary in severity. This variability may be due to the size and firmness of the nodules. Other common symptoms include difficulty producing vocal pitches in the higher range, increased phonatory effort, and vocal fatigue. There may be a sensation of soreness or pain in the neck, lateral to the larynx, which generally occurs because of the increased effort needed to produce the voice.

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