Synonyms in the broader sense

Medical: phonation nodules

Corns of the vocal folds, vocal cord nodules

definition

The vocal fold nodules (phonation nodules or vocal cord nodules) are counted among the benign tumors of the larynx. Although it is also called a "tumor on the vocal folds", yet it is not a scattering (metastatic) cancer (cancer of the larynx).
Cleparatric nodules can occur at any age and cause a significant reduction in our voice and speech quality. The hoarseness and harsh voice are the main symptoms. The vocal cord nodules can be well treated by gentle voice treatment or by small surgical procedures.

causes

In general, an overuse of the vocal cords is the cause of the development of the nodules.

This overuse can have different reasons for individual reasons. For example, those who are particularly vocal in their vocation, such as singers or teachers, are particularly affected.
Why some people are more inclined to the development of voice nodules than others is not yet fully understood.

A wrong voice technique will be responsible as a causative factor in some cases. Another group of people with a history of vocal nodules is babies, who scream a lot ("writing babies").
If possible, the cause of the many screams should be found in these children to prevent the development of the nodules. In principle, the overloading of the vocal cords causes water retention, which leads to so-called soft nodules. These can usually regress through the protection of the voice. With continuous loading of the vocal cords, so-called hard nodules form on the floor of these soft nodules, which must be surgically removed.
Because the vocal cords no longer fit perfectly through the nodules, the familiar hoarse voice is created when speaking.

precancerous

A precancerous lesion is a change in the tissue, which can manifest as mucosal proliferation ( polyp ), for example. It was a potential precursor to a malignant tumor or may even be in transition to malignant cancer.
However, the vocal fold nodules are a benign growth and not a precancerous lesion because the nodules are caused by overuse of the vocal folds. Often, the nodules form after successful therapy back by itself.

Distinguished from the harmless vocal cord nodules is the so-called laryngeal papillomatosis, in which mucous membrane nodules can form in the entire larynx, including on the vocal folds. These are usually caused by an infection with the Human Papilloma Virus (HPV), which can usually be transmitted by oral sex. These represent a precancerous lesion and can thus turn into a malignant cancer of the larynx.

formation

Above all, vocal cord nodules get people who use their voice constantly and intensively.
These include certain professional groups such as:

  • Singer
  • Teacher
  • and some politicians.

Some develop voice nodules, although they do not strain their voice excessively. Here is probably a wrong vocal technique.
Constantly conscious high-level speech or the imitation of different sounds can also lead to a nodule formation on the vocal folds.

symptoms

In the presence of vocal cord nodules, it is difficult to speak loud and strong.
The body defends itself against a voice overload. The voice gets rougher and hoarser and you feel like you have to clear your throat constantly to get a clear voice again.
But hawking brings no relief. Hoarseness and rough voice disappear only after an adequate therapy.

The main symptom of vocal cord nodules is a so-called dysphonia ( voice disturbance ). How pronounced the disorder is can be very different individually.
In general, however, the number and size of the nodules and the quality of the voice correlate with each other.

The change of voice can be described with different qualities. Mostly adjectives like hoarse, rough, occupied or breathy are used. Also the feeling of having to clear your throat is typical for the presence of vocal cord nodules. However, clearing your throat will never actually improve the voice. In some cases, vocal cord nodules can even lead to people being unable to speak for a certain period of time.
The voice disturbance associated with the vocal cord nodules is usually perceived by the affected persons as very disturbing. If the nodules do not persist for some time, the symptoms return after some time with the sound being saved. The recurrence of the disorder as well as the nodules is in frequently affected individuals, however, why can be advised to a general voice preservation.

diagnosis

In case of prolonged hoarseness and restriction of voice, the family doctor will refer you to an ENT doctor. With a laryngoscopy (laryngoscopy) he will be able to observe the glottis exactly.
Small changes such as nodules are quickly detected and identified by an experienced ENT specialist. Of course, behind a swelling or a nodule can hide another finding. But then the examining doctor decides on further examinations.

therapy

If it's just minor nodules that have been causing discomfort such as hoarseness and a harsh voice for a short time, the ENT specialist will recommend you to get a voice saver first. In some professions, such as that of the teacher, one can not pass much speech.
In this case, the specialist will issue you a certificate. In the so-called Schreikinder further diagnostic measures may be appropriate to find out the cause of the excessive cry.
Pediatricians, psychologists and neurologists can be typical contact points for diagnosticians in crying children.
Even if you do not improve after taking care of your voice, the doctor will discuss with you the possibility of a change of profession and explain the benefits of long-term vocal care.
For larger, hard nodules, which almost completely block the voice, there is the possibility of surgical removal. This is a minor procedure that usually does not lead to any major complications. Nevertheless, after the operation, a longer voice preservation must be planned.

vocal exercises

In the acute phase, the voice should be spared as much as possible.
Voice exercises should nevertheless be used to avoid a renewed vocal cord overload. The exercises should also be repeated daily.

The patient may start with an exercise that strengthens the diaphragm, as the diaphragm is important for a strong voice and thus can relieve the vocal cords. The exercise takes place in a straight sitting posture. The sounds "Psst" and "Ksch" are spoken alternately. During exercise, good body tension and posture should be considered.
Another vocal exercise is, for example, the so-called "squeaking". In doing so, the patient imitates a chewing motion with his mouth open, sounding the sounds "mmmh" and "mjam". Also, singing "nnn" and "mmm" in a melody (for example, a scale) trains the vocal cords. Care should be taken not to sing too low or too high a note, otherwise the vocal cords will be overstretched again. There are many more exercises that should be discussed individually with a speech therapist.

speech therapy

Speech therapy (speech and speech therapy) is an important means to treat the vocal cord nodules and symptoms. Patients should definitely seek professional treatment. Especially when - as is often the case - a profession is practiced where much is said (for example, teachers). In the logopedic sessions, breathing exercises and finding the right voice are trained with the patients. These exercises can then be performed by the patient daily at home.
If the speech therapy does not show any results after a few weeks, the operative removal of the nodules should be considered.

Operative therapy

An operative removal of the vocal cord nodules is not necessary in most cases.

Thus, after a preservation of the vocal cords, the lumps tend to spontaneously develop, with the disturbing symptoms also decreasing.
However, it may be that only surgery to remove the nodules brings improvement. This is especially the case if the vocal cords are not spared after initial nodule formation. In these cases, it can happen that on the already formed, so-called soft knots, hard knots form.
These can then only be removed with one operation. Specialists in the field of these operations are specialists in ear, nose and throat medicine. The surgery itself is a minor procedure and usually does not involve serious complications.

However, since each operation brings a certain residual risk, it is advisable to spare the voice directly after nodule formation so as to avoid the operation. It should also be mentioned that despite performed surgery, if the vocal cords continue to be overloaded, nodules may continue to develop. Thus, at the beginning of the disease, a preservation of the vocal cords as well as a speech therapy with a speech therapist / in an operation is preferable.

Vocal cord nodules in children

Even children and babies can develop such nodules by excessive crying (so-called "screaming children"). This is often due to hoarseness of the children.

In children who are overly loud and speak a lot or even scream, it can also lead to vocal cord nodules. That is why these are also called "crying balls" in children. As in adults, symptoms such as hoarseness, rough voice and constant hawking occur. Since a hearing loss could also be behind the loud talking of the child, a doctor should examine the hearing.
It is important that the child starts therapy early so that the vocal folds are quickly spared. In doing so, the child should learn how to use the voice in a calm way. Since children often want to be heard through loud speaking, parents can also promote therapy by providing a quiet environment for the child. In most cases, the vocal fold nodules then disappear again until puberty.


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