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Vocal Nodules: Treatment

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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Is surgery the best treatment for vocal fold nodules?

Question: A few months ago I developed a hoarse and raspy voice that never seemed to get better. Speaking gradually became uncomfortable. My physician diagnosed me with vocal fold nodules and suggested that I have them surgically removed so that my symptoms would resolve. I am a litigation lawyer and admittedly overtax my voice on a daily basis. My voice is integral to my livelihood and I would ideally want to protect it. I have heard of bad results with vocal fold surgery and do not want to risk losing any voice quality. Is surgery the best method of treatment for vocal fold nodules?

Answer:

In most cases, surgery is not the optimal treatment for vocal fold nodules and should be reserved as a measure of last resort. The potential complications and vocal changes associated with vocal nodule surgery make it an undesirable option for most patients who use their voice for a living. Typically, if treated in a timely manner, vocal nodules can be reversed through non-surgical voice therapy and vocal function can be restored.

Figure 1: Stroboscopy image of the vocal folds demonstrating bilateral vocal nodules (arrow)
Figure 1: Stroboscopy image of the vocal folds demonstrating bilateral vocal nodules (arrow)

Vocal fold nodules most commonly develop from chronic vocal fold misuse. It is a common misperception that ones voice should be hoarse or rough after a long day of use. Most people are usually not aware that they are misusing their voice in these instances. Much like everything else, there is a proper technique to voice usage and, if used correctly, these symptoms should not occur. Oftentimes, nodules develop in individuals that either start off with improper voice technique or subsequently develop it during periods of stressful voice use. Another common scenario is development of improper technique during an illness to compensate for a weakened voice. In any case, timely treatment is suggested to avoid permanent damage to the voice.

The gold standard treatment for vocal fold nodules is voice therapy from a qualified voice therapist. A voice therapist has completed training in speech and language pathology as well as specialty training in voice therapy. These specialists work with patients to modify their method of voice production, promote vocal fold healing, and remove harmful vocal habits. In addition, a vocal therapist can customize a treatment plan around a patient’s unique issues and capabilities. In treating vocal nodules, a voice therapist will specifically assist the patient in recognizing and replacing the harmful voice techniques that have led to the formation of nodules. Replacing the improper technique has a two-fold effect on a patient’s vocal health; existing nodules begin to regress and heal and future nodules are prevented from developing.

Figure 2: Voice therapy is the gold standard for vocal nodule prevention and treatment.
Figure 2: Voice therapy is the gold standard for vocal nodule prevention and treatment.

Surgery is a treatment option that should rarely, and only, be utilized for treatment of older nodules that produce significant vocal impairment and are refractory to voice therapy. Surgical removal of a vocal fold nodule will cause the formation of scar tissue, permanently affecting the quality of the voice. In most cases vocal range will be reduced. Surgery can only be rationalized when all other attempts of treating the nodule have been exhausted and the presence of the nodule causes more vocal impairment than the surgical intervention would. In addition surgery should only be considered after expert evaluation by a qualified laryngologist using stroboscopy. These specialized physicians are specifically trained in recognizing and treating conditions of the voice. Because of the high rate of vocal fold nodule misdiagnosis, it is of critical importance to be confident that the diagnosis is correct and appropriate before undergoing any procedure.

Key Points:

  • In most cases, surgery is not the optimal treatment for vocal fold nodules and should be reserved as a measure of last resort for refractile nodules.
  • Typically, if treated in a timely manner, vocal nodules can be reversed through non-surgical voice therapy and vocal function can be restored.
  • The gold standard treatment of vocal fold nodules is voice therapy from a qualified voice therapist.
  • The role of the vocal therapist is to help the patient recognize these issues and replace them with proper technique.
  • Replacing the improper technique has a two-fold effect on a patient’s vocal health; existing nodules begin to heal and future nodules are prevented from developing.
  • Surgery can only be rationalized when all other attempts at treating the nodule have been exhausted and the presence of the nodule causes more vocal impairment than the surgical intervention would.

To learn more about Dr. Reena Gupta or vocal nodule treatment, please visit www.voicedoctorla.com.

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