Voice: Structural

Vocal fold nodules are small, benign (non-cancerous) growths that form on the vocal folds (also known as vocal cords). These nodules develop as a result of vocal strain or overuse and are most commonly seen in people who use their voice a lot, such as singers, teachers, or public speakers.

The vocal folds are two muscles located in the larynx (voice box) that vibrate to produce sound when air passes through them. When these muscles are overused, the repetitive stress can cause inflammation, leading to the formation of nodules.

Vocal fold nodules are usually caused by activities or conditions that lead to vocal strain or repeated trauma to the vocal folds. Common causes include:

• Excessive talking or shouting: Frequent yelling or speaking loudly for long periods can put a strain on the vocal folds.
• Poor vocal technique: Using improper breathing or voice techniques while speaking or singing can lead to vocal strain.
• Environmental factors: Dry air, smoking, or exposure to irritants can increase the risk of developing nodules.
• Gastroesophageal reflux disease (GORD): Stomach acid can irritate the vocal folds and contribute to nodule formation.
• Singing without proper training: Singers who use incorrect techniques may be more prone to developing nodules.

The symptoms of vocal fold nodules are often related to how much the condition affects the vibration of the vocal folds. Common symptoms include:

• Hoarseness or a raspy voice
• Voice fatigue or feeling like the voice is “tired” after speaking or singing
• Reduced vocal range (difficulty reaching higher or lower pitches)
• Frequent throat clearing or the sensation of a lump in the throat
• Breathing difficulties in severe cases
• Loss of vocal control or an inability to speak loudly

The symptoms may worsen with prolonged talking or singing and improve with rest. However, without proper treatment, the nodules may persist or worsen over time.

If you experience symptoms of hoarseness or vocal fatigue, it's important to see an ear, nose, and throat (ENT) specialist or a laryngologist. They will evaluate your symptoms and perform the following:

• Laryngoscopy: A procedure where a small camera (flexible endoscope) is passed through the nose or mouth to view the vocal folds directly. This allows the doctor to see the nodules and assess the severity of the condition.
• Voice assessment: A speech-language therapist (SLT) may also evaluate your voice and vocal function. This helps determine the extent of the damage to the vocal folds and whether additional therapy is needed.
• Medical history: The doctor will ask about your voice use habits, any history of vocal strain, or other contributing factors like GORD.

Treatment for vocal fold nodules is aimed at reducing inflammation, allowing the vocal folds to heal, and improving voice technique. Common treatment options include:

1. Conservative Treatment

• Voice rest: Giving your voice time to rest is crucial for allowing the nodules to heal. This means reducing talking, singing, or any vocal strain.
• Hydration: Drinking plenty of fluids helps to keep the vocal folds moist and reduces irritation.
• Humidification: Using a humidifier in your home or work environment can help prevent dryness in the air, which can irritate the vocal folds.
• Avoiding irritants: Reducing or eliminating smoking, excessive alcohol, or exposure to environmental irritants is important for recovery.
• Treating GERD: If you have gastroesophageal reflux disease, managing the condition with medication or dietary changes can help reduce irritation to the vocal folds.

2. Voice Therapy

• Speech-language therapy: A speech therapist can help you learn proper vocal techniques and improve your vocal hygiene. This may include exercises to strengthen the muscles of the vocal folds, correct improper breathing, and teach techniques to avoid strain during speaking and singing.

Voice therapy is often the first line of treatment, and many people experience significant improvement with this approach alone.

3. Surgical Treatment

• Surgery: If vocal rest and voice therapy do not resolve the problem and the nodules persist, surgery may be considered. The procedure is called a microlaryngoscopy, in which the surgeon removes the nodules using a laser or small surgical instruments. However, surgery is generally reserved for more severe cases or those that do not improve with other treatments.

While most people with vocal fold nodules can recover fully with appropriate treatment, there are some risks and potential complications to be aware of:

• Voice changes: Treatment, especially surgery, can lead to temporary or permanent changes in the voice, although this is rare.
• Recurrence: Without addressing the underlying cause of the nodules (such as vocal overuse or poor technique), nodules may recur even after treatment.
• Scarring: In some cases, surgery may lead to scarring of the vocal folds, which can affect voice quality and function.

To prevent vocal fold nodules from developing, it is important to practice healthy vocal habits. Here are some tips to protect your voice:

• Use proper vocal technique: Whether you're speaking or singing, always use the right breathing and voice techniques to avoid strain. Consider working with a voice teacher or speech therapist to learn good habits.
• Rest your voice: Avoid overusing your voice. If you need to talk or sing for long periods, take regular breaks.
• Stay hydrated: Drink plenty of water to keep your vocal folds lubricated.
• Avoid smoking and irritants: Smoking, alcohol, and exposure to pollutants can damage your vocal folds and increase the risk of nodules.
• Manage acid reflux: If you suffer from GORD, work with your doctor to control the reflux and prevent acid from irritating your vocal folds.

The prognosis for vocal fold nodules is generally very positive with appropriate treatment. Most people experience significant improvement after a period of voice rest and voice therapy. Surgery may be needed in more persistent cases, but with good vocal hygiene and technique, the risk of recurrence can be minimized.

The majority of patients can return to normal vocal use after treatment, although it may take time for full recovery. In most cases, the voice will continue to improve over several weeks or months following treatment.

See your doctor or an ENT specialist if you experience:

• Persistent hoarseness or voice changes lasting longer than two weeks
• Voice fatigue or weakness after speaking or singing
• Frequent throat clearing or a feeling of something stuck in your throat
• Difficulty hitting higher or lower notes when singing

What are Vocal Fold Nodules?

Small, benign growths on the vocal folds caused by vocal strain or overuse

Causes

Overuse, poor vocal technique, irritants (smoking, GERD), singing without proper training

Symptoms

Hoarseness, voice fatigue, reduced vocal range, throat clearing

Treatment

Voice rest, hydration, voice therapy, surgery (if needed)

Prevention

Good vocal hygiene, proper technique, hydration, avoiding irritants

Prognosis

Generally positive with treatment; most recover fully with voice therapy and rest

Vocal fold polyps and cysts are benign (non-cancerous) growths that develop on the vocal folds (also known as vocal cords). These growths can interfere with the normal vibration of the vocal folds, leading to changes in your voice.

• Vocal fold polyps are typically caused by sudden trauma or strain on the vocal folds, such as excessive talking, shouting, or singing. They appear as swollen, fluid-filled lesions.
• Vocal fold cysts are fluid-filled sacs that form within the tissue of the vocal folds. Cysts can be caused by glandular blockages or chronic irritation to the vocal folds.

Both conditions can cause hoarseness, vocal fatigue, and other voice-related symptoms, affecting your ability to speak or sing clearly.

Vocal fold polyps and cysts are often the result of vocal strain or irritation. The common causes include:

1. Excessive vocal strain or overuse: Frequently shouting, talking loudly for long periods, or singing without proper technique can cause trauma to the vocal folds, leading to polyps or cysts.
2. Smoking: Smoking can irritate the vocal folds, leading to inflammation and increased risk of growths.
3. Gastroesophageal reflux disease (GORD): Acid reflux can irritate the vocal folds, making them more vulnerable to injury and growths.
4. Chronic laryngitis: Ongoing inflammation of the vocal folds, often caused by infections or irritants, can increase the likelihood of developing polyps or cysts.
5. Environmental irritants: Exposure to pollutants, chemicals, or dry air can harm the vocal folds and contribute to growth formation.
6. Surgical procedures or trauma: Previous surgeries on the vocal folds or trauma to the larynx can also lead to the development of polyps or cysts.

Vocal fold polyps and cysts can cause a variety of symptoms, which can range from mild to severe. Common symptoms include:

• Hoarseness: A rough, raspy, or breathy voice is one of the most common symptoms.
• Voice fatigue: Feeling like your voice becomes tired or weak after speaking or singing for long periods.
• Difficulty hitting high or low notes: If you are a singer, you may notice a reduced vocal range.
• Frequent throat clearing: A feeling of something in your throat may lead to the urge to clear it often.
• Throat discomfort: Some people experience pain or a sensation of something stuck in the throat.
• Breathiness: A weak or airy voice may be present, as the vocal folds are not closing properly due to the growth.
• A change in voice quality after vocal strain: Symptoms often worsen after speaking or singing for long periods.prove their mobility and overall physical wellbeing.

If you experience persistent voice changes or symptoms like hoarseness or vocal fatigue, it’s important to consult an ear, nose, and throat (ENT) specialist or laryngologist. The doctor will evaluate your symptoms and typically perform the following diagnostic tests:

1. Laryngoscopy: This is the first step in diagnosing vocal fold polyps and cysts. A flexible camera (endoscope) is inserted through the nose or mouth to examine the vocal folds and detect any growths.
2. Stroboscopy: This specialized test uses a flashing light to capture the movements of the vocal folds in real time. It helps the doctor assess how well the vocal folds are vibrating and if the growths are affecting their movement.
3. Voice assessment: A speech-language pathologist (SLP) may evaluate your voice function to determine the extent of the voice changes and assess how the polyps or cysts affect your vocal performance.

Treatment for vocal fold polyps and cysts is aimed at reducing symptoms, preventing further damage to the vocal folds, and improving voice quality. The treatment options depend on the severity of the condition.

1. Conservative Treatment

For mild cases, treatment may focus on relieving symptoms and promoting healing:

• Voice rest: Giving your vocal folds time to rest is essential for recovery. This means reducing speaking, singing, or any activities that put strain on the vocal folds.
• Hydration: Drinking plenty of fluids and using a humidifier can help keep your vocal folds moist and reduce irritation.
• Avoiding irritants: Minimizing exposure to smoking, alcohol, and environmental pollutants can reduce inflammation and promote healing.
• Treating GORD: If acid reflux is contributing to the condition, medications or lifestyle changes to manage reflux may help alleviate symptoms.
• Voice therapy: A speech-language pathologist (SLP) can work with you to improve your vocal technique, teach proper breathing, and help you develop healthy speaking habits. Voice therapy can also help you avoid further strain on the vocal folds.

2. Surgical Treatment

If conservative measures do not improve the condition, or if the polyps or cysts are large or cause significant voice problems, surgery may be recommended. Surgical options include:

• Microsurgery: In this procedure, a surgeon uses small instruments or a laser to remove the polyp or cyst. This is often done under general anesthesia and may require a short recovery time.
• Vocal fold cyst drainage or removal: If a cyst is present, it may be drained or surgically removed to restore proper vocal fold function.

Surgery is usually recommended when the polyps or cysts significantly affect voice quality or do not improve with conservative treatment.

Like any medical treatment, there are risks associated with managing vocal fold polyps and cysts:

• Voice changes: Both surgical and non-surgical treatments can result in temporary or permanent changes to the voice, including hoarseness or breathiness.
• Scarring: Surgery to remove a polyp or cyst may lead to scarring on the vocal folds, which could affect voice quality.
• Recurrence: Without proper vocal care and technique, polyps or cysts may recur, especially if the underlying causes (e.g., vocal strain, smoking, GORD) are not addressed.
• Incomplete removal: In rare cases, the entire polyp or cyst may not be removed, requiring further treatment or surgery.

While vocal fold polyps and cysts cannot always be prevented, the following tips can help reduce the risk of developing them:

• Use proper vocal technique: Whether you are speaking or singing, using correct breathing and vocal techniques can reduce strain on your vocal folds.
• Voice rest: Avoid overusing your voice. If you talk or sing for long periods, take regular breaks to give your vocal folds time to recover.
• Stay hydrated: Drink plenty of water to keep your vocal folds moist and reduce irritation.
• Avoid smoking and irritants: Smoking and exposure to pollutants can harm the vocal folds, so avoiding these can help protect your voice.
• Manage reflux: If you have gastroesophageal reflux disease (GORD), work with your doctor to control it and reduce the risk of vocal fold irritation.

The prognosis for individuals with vocal fold polyps and cysts is generally good with appropriate treatment. Many people experience significant improvement in their voice after voice rest, therapy, and, in some cases, surgery.

With proper care, most people can return to normal vocal function. However, without addressing the underlying causes of polyps or cysts (such as vocal overuse or reflux), there is a risk of recurrence

What are Vocal Fold Polyps and Cysts?

Benign growths on the vocal folds, often caused by vocal strain or irritation

Causes

Vocal overuse, smoking, GORD, environmental irritants, chronic inflammation

Symptoms

Hoarseness, voice fatigue, breathiness, reduced vocal range, throat discomfort

Treatment

Voice rest, hydration, voice therapy, surgery (if necessary)

Prevention

Proper vocal technique, voice rest, hydration, avoiding irritants, managing reflux

Prognosis

Positive with treatment, voice therapy, and surgery; recurrence possible without proper care

A vocal process granuloma is a benign growth that forms on the vocal process of the arytenoid cartilage, which is located at the back of the vocal folds. These granulomas develop due to irritation or trauma and can cause voice changes and discomfort.

• Hoarseness or rough voice quality
• Throat pain or discomfort, especially while speaking or swallowing
• Sensation of something stuck in the throat
• Frequent throat clearing
• Chronic cough
• Vocal fatigue or reduced voice endurance

Vocal process granulomas often develop due to:

• Laryngopharyngeal reflux (LPR) – Stomach acid irritating the larynx
• Vocal trauma or misuse – Excessive throat clearing, loud talking, or prolonged voice use
• Intubation injury – Trauma from a breathing tube during surgery
• Chronic coughing or throat clearing – Leading to irritation of the vocal folds
• Postnasal drip and allergies – Causing throat irritation

An ear, nose, and throat (ENT) specialist will diagnose a vocal process granuloma through:

• Laryngoscopy or videostroboscopy – Using a camera to examine the larynx
• Voice assessment – Evaluating symptoms and vocal function
• Acid reflux evaluation – If LPR is suspected as a contributing factor

Treatment aims to reduce irritation and promote healing.

1. Voice Therapy and Behavioural Changes

• Reducing throat clearing and coughing – Using alternative strategies to prevent irritation
• Proper voice techniques – Learning how to use the voice efficiently with minimal strain
• Avoiding vocal abuse – Minimizing excessive speaking, shouting, or straining the voice

2. Medical Management

• Acid reflux treatment – Proton pump inhibitors (PPIs) or dietary changes to reduce LPR-related irritation
• Anti-inflammatory medications – To reduce swelling and irritation
• Pain management – If discomfort is significant

3. Botulinum Toxin (Botox) Injection

• In some cases, Botox injections into the laryngeal muscles may be used to reduce excessive vocal fold movement and tension, helping the granuloma heal by minimising further irritation.

4. Surgical Removal (If Necessary)

• If the granuloma persists despite conservative treatments, a surgical procedure may be performed to remove it. However, addressing underlying causes is essential to prevent recurrence.

With appropriate treatment, most granulomas heal without surgery. However, if the underlying cause is not managed, recurrence is possible. Proper voice care, medical management, and behavioural changes are key to long-term recovery.

Vocal process granuloma is a treatable condition, often resolving with voice therapy, medical management, and lifestyle changes. Early intervention and proper care can help prevent recurrence and maintain vocal health.

Vocal fold sulcus is a condition in which a groove or indentation forms on one or both of the vocal folds (also known as vocal cords). The groove can be shallow or deep and can affect the normal vibration of the vocal folds, leading to voice problems.

The vocal folds are two muscles in the larynx (voice box) that vibrate to produce sound when air passes through them. If a sulcus forms, the groove can disrupt their smooth movement and cause changes in the voice, such as hoarseness or weakness.

The exact cause of vocal fold sulcus is often unclear, but several factors are believed to contribute to its development:

1. Congenital Sulcus: In some cases, vocal fold sulcus is present from birth (congenital). This may be due to developmental issues during foetal growth, which lead to an abnormality in the vocal fold structure.
2. Acquired Sulcus: In other cases, vocal fold sulcus develops later in life. Possible causes include:
   • Vocal trauma: Excessive or improper vocal use, such as shouting or speaking loudly for extended periods.
   • Vocal overuse: Constant use of the voice without proper vocal care, often seen in singers, teachers, and speakers.
   • Inflammation: Long-term inflammation from conditions such as chronic laryngitis or gastroesophageal reflux disease (GORD) can cause tissue changes in the vocal folds.
   • Surgical injury: Surgical procedures involving the vocal folds, such as those done for other voice conditions, may lead to scarring or the development of sulcus.

Vocal fold sulcus can cause a variety of symptoms, depending on the severity and extent of the groove. Common symptoms include:

• Hoarseness: A rough or raspy voice, especially when speaking or singing.
• Voice fatigue: Feeling like your voice becomes tired or weak after speaking or vocalising for a while.
• Reduced vocal range: Difficulty reaching higher or lower pitches, especially when singing.
• Breathiness: A weak or airy voice, as the vocal folds may not come together properly due to the groove.
• Throat discomfort: A feeling of tightness or discomfort in the throat, especially when speaking for long periods.
• Frequent throat clearing: A tendency to clear the throat frequently due to irritation or a sensation of something in the throat.

In more severe cases, vocal fold sulcus may cause significant voice impairment, making it difficult to communicate effectively.

If you are experiencing voice changes or symptoms like hoarseness or vocal fatigue, it’s important to consult an ear, nose, and throat (ENT) specialist or laryngologist for a thorough evaluation. The doctor will typically perform the following tests:

1. Laryngoscopy: A flexible camera (endoscope) is inserted through the nose or mouth to visualize the vocal folds. This allows the doctor to identify the presence of a sulcus and assess its severity.
2. Stroboscopy: A special type of endoscopy that uses flashing light to capture the vibrations of the vocal folds in real-time. This helps to assess how well the vocal folds are vibrating and how the sulcus affects their movement.
3. Voice assessment: A speech-language therapist (SLT) may evaluate your voice function, vocal range, and vocal fatigue. This is helpful in determining the extent of the impact on your voice and planning treatment.

Treatment for vocal fold sulcus depends on the severity of the condition and the symptoms you are experiencing. Treatment options include:

1. Conservative Treatment

For less severe cases, non-surgical treatments may help manage symptoms and improve vocal quality:

• Voice rest: Giving your voice time to rest and recover is essential. Avoid excessive talking, shouting, or any activities that put strain on the vocal folds.
• Hydration: Keeping your vocal folds moist by drinking plenty of fluids and using a humidifier can help alleviate dryness and irritation.
• Voice therapy: A speech-language therapist can work with you to teach proper vocal techniques, such as breath support and relaxation exercises. These techniques can reduce strain on the vocal folds and improve voice quality.

2. Surgical Treatment

In cases where symptoms are severe or do not improve with conservative treatment, surgery may be considered. Surgical options for vocal fold sulcus include:

• Microsurgical repair: This involves a delicate procedure in which a surgeon may remove or repair the sulcus, depending on its depth and impact on vocal fold function.
• Vocal fold augmentation: In cases where the sulcus causes a significant loss of tissue in the vocal fold, augmentation may be performed. This involves injecting a material (such as fat or collagen) to fill the groove and restore the shape and function of the vocal fold.

Surgical treatment is typically considered after voice therapy has been attempted and in cases where there is significant functional impairment of the voice.

As with any medical procedure, there are risks and potential complications to consider:

• Voice changes: While treatment (especially surgery) is intended to improve voice function, there may be temporary or permanent changes in the voice, including increased hoarseness or breathiness.
• Scarring: Surgery to repair the vocal fold sulcus can lead to scarring, which could affect the voice quality. However, surgeons use precise techniques to minimise scarring.
• Recurrent sulcus: In some cases, the sulcus may return after treatment, especially if the underlying cause (such as vocal overuse) is not addressed.

The outlook for individuals with vocal fold sulcus depends on the severity of the condition and the treatment used. Many people experience improvement in their voice with proper treatment, particularly voice therapy.

In more severe cases, surgery can significantly improve voice quality, although some residual symptoms (like breathiness or mild hoarseness) may remain. The key to a positive outcome is early diagnosis, appropriate treatment, and good vocal hygiene.

What is Vocal Fold Sulcus?

A groove or indentation on the vocal folds that affects voice quality

Causes

Congenital, vocal trauma, overuse, inflammation, or surgical injury

Symptoms

Hoarseness, voice fatigue, reduced vocal range, breathiness, throat discomfort

Treatment

Voice rest, hydration, voice therapy, surgical repair (if needed)

Prevention

Proper voice technique, hydration, avoiding irritants, managing reflux

Prognosis

Positive with treatment; voice therapy and surgery can improve symptoms