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MEET THE DOCTORS 2018

Dr. Hamilton and Dr. Osborne will be in:

Dr. Hamilton and Dr. Osborne will be in:

London, UK February 2018
Belgrade February 2018
NYC: April 25
ORLANDO: April 26
HOUSTON: April 27

Vocal Nodules: Diagnosis

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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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?

Answer:

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.

Figure 1: Illustration depicting normal vocal cords (right) and vocal cord nodules (left).
Figure 1: Illustration depicting normal vocal cords (right) and vocal cord nodules (left).

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.

Figure 2: High-resolution video stroboscopy image depicting two vocal cord nodules.
Figure 2: High-resolution video stroboscopy image depicting two vocal cord nodules.

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.

Key Points:

  • 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.

Contact a Physician at Osborne Head & Neck Institute

If you would like to speak with one of our physicians regarding this issue or another ear, nose, throat problem; or have other questions or concerns, please complete the contact form below or call us at 310-657-0123.
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