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How can I tell if I have developed vocal nodules?
Question: I am an aspiring singer and have been struggling with my voice lately. I have noticed that I have a rough and raspy voice that has progressively worsened over the last month. My neck feels tight and I have to strain to produce pitches that were once easily within my range. I am very concerned that I may have developed vocal nodules as a result of overusing my voice. How can I tell if I have developed vocal nodules?
Vocal nodules develop from chronic vocal cord abuse. This includes:
Vocal nodules are commonly associated with a constellation of symptoms including, progressively worsening hoarseness, breathiness, rough or scratchy voice, or decreased pitch range. Additionally, patients sometimes complain of, neck tightness or discomfort, diminishing voice quality with use, and vocal exhaustion. It is important to note that these symptoms are not exclusively seen with vocal nodules and could potentially indicate a different vocal issue.
Ultimately, the best way to determine if you have vocal nodules is to be evaluated by a qualified physician who specializes in the voice, a laryngologist. Laryngologists are physicians who have completed a medical residency in otolaryngology (ENT) and have additionally completed a subspecialty in laryngology. These physicians dedicate their practice exclusively to vocal health and disorders that affect the voice box (larynx). Additionally, while various traditional otolaryngologists (ENTs) claim to be “voice doctors”, only a laryngologist has the focused expertise to effectively diagnose and treat the subtleties inherent to vocal health and function. Laryngologists also receive specialized training to recognize rare and commonly misdiagnosed disorders of the voice.
During your evaluation with a qualified laryngologist, the physician will take an extensive voice history, perform a general ENT exam, and examine your vocal cords directly with video stroboscopy. Previously, the greatest challenge surrounding evaluation of vocal nodules and other voice pathology was diagnostic confidence. Recent advances in medical imaging have placed stroboscopy at the forefront of laryngeal imaging and vocal evaluation. Stroboscopy is now the gold standard for voice evaluation and allows the physician to visualize the vocal cords during speech. These high definition images of laryngeal structures are far superior to traditional flexible fiberoptic laryngoscopy (FFL) procedures that are still used in many offices today. Stroboscopy removes the uncertainty and guesswork from the diagnosis of vocal cord nodules. Many disorders that were previously misdiagnosed with FFL are now clearly differentiated with stroboscopy.
Dr. Reena Gupta, director of the Osborne Head and Neck Institute’s division of Voice and Laryngology is an acclaimed laryngologist with extensive experience in the evaluation and treatment of vocal cord nodules. As a singer herself, Dr. Gupta can relate to the concerns of anyone who uses their voice for a living. Her sophisticated approach to the voice ensures that patients receive the highest quality of care available. Dr. Gupta routinely collaborates with voice therapist, Amy Chapman in a multidisciplinary effort to formulate a custom, comprehensive, and efficacious evaluation and treatment plan for her vocal nodule patients.
- Common symptoms associated with vocal nodules include progressively worsening hoarseness, breathiness, rough or scratchy voice, decreased pitch range, neck tightness or discomfort, diminishing voice quality with use, and vocal exhaustion.
- Vocal nodule symptoms are seen in various other disorders. It is difficult to conclusively know if you have vocal nodules by symptom evaluation alone.
- Timely evaluation by a voice specialist, a laryngologist, is highly advised if vocal nodules are suspected.
- Stroboscopy is the gold standard for comprehensive evaluation of laryngeal pathology including vocal nodules.
- Older technology such as flexible fiberoptic laryngoscopy (FFL) is prone to misrepresentation of lesions that look similar under low-resolution imaging.