Vocal Cord Nodules: Unveiling the Hidden Culprits of Hoarseness

What you’ll learn:

• Why vocal cord nodules develop and how do they contribute to hoarseness
• What the key differences between vocal cord nodules and polyps are
• How to treat vocal cord nodules and when surgical intervention is necessary

If you’re experiencing persistent hoarseness, don’t hesitate to contact NJENT to schedule an appointment with one of our experienced ENT specialists. We offer a range of diagnostic and treatment options to help you find relief. You can visit our New Jersey office or book a virtual consultation from the comfort of your own home. If you enjoyed this episode, be sure to like and subscribe to our channel for more informative content, and tune in next time for our next discussion. Thanks for listening!

Listen to the audio version below.

Audio Transcript:

Dr. Smith: Nodules are probably one of the most common causes of hoarseness when it comes to the underlying diagnosis of the reason for the hoarseness. And nodules are essentially these little calluses or bumps that start to form on the vocal cords. along the vibrating part of the vocal cords. And so if you think of it like a stringed instrument, the vocal cords vibrate to make sound or music. And these little calluses can start to form, which then hinder the ability of the vocal cords to vibrate in a normal motion.

Dr. Reddy: Hey guys, how’s everyone?

Dr. Smith: Hi!

Dr. Reddy: So I’m Dr. Reddy, this is Dr. Smith. We are here coming from NJENT. Today’s episode we’re going to be discussing is something called vocal cord nodules. Vocal cord nodules are a pretty common cause of hoarseness that we see in the office. And so first, we’re going to have Dr. Smith just go over what vocal cord nodules are.

Dr. Smith: Okay, so as Dr. Reddy was saying, hoarseness is something that we see very commonly in our office. We see a complaint from a lot of professional voice users, whether it be singers or teachers, salespeople, lawyers, someone who’s constantly using their voice a lot, they come in with a complaint of hoarseness or the inability to use their voice like they typically do. And it may seem kind of subtle to some people, but the hoarseness seems to affect their quality of life or their ability to perform their job or sing. And so we often see patients for the complaint of hoarseness. Nodules are probably one of the most common causes of hoarseness when it comes to the underlying diagnosis of the reason for the hoarseness. And nodules are essentially these little calluses or bumps that start to form on the vocal cords. along the vibrating part of the vocal cords. And so if you think of it like a stringed instrument, the vocal cords vibrate to make sound or music. And these little calluses can start to form, which then hinder the ability of the vocal cords to vibrate in a normal motion.

Dr. Reddy: Yep. And vocal cord nodules are very commonly confused with vocal cord polyps, right? So oftentimes we’ll see patients. have a history saying that they have a history of vocal cord polyp and in reality, it might be a vocal cord nodule. But some of the differences are vocal cord nodules tend to be on both sides of the vocal cords. So if you have your vocal cords that kind of open when you’re breathing and closing when you’re phonating, if you develop a little bit of a callus or a nodule on one side, you can develop a contralateral or opposite side callus or nodule on the other side. And therefore usually vocal cord nodules are bilateral. on both sides, whereas a vocal cord polyp is typically on one side. And usually most vocal cord nodules can be treated conservatively without a surgery. There are some cases where you need a surgery, whereas with a vocal cord polyp, oftentimes they need to be removed with a surgical procedure. So what are some ways that we can treat vocal cord nodules conservatively?

Dr. Smith: Sure. So… You know, the first thing is to make sure that they are vocal cord nodules. So, you know, typically we recommend if the hoarseness has been going on for more than four to six weeks to come in and get evaluated by an ENT such as ourselves. So we can take a look down at the vocal cords and there’s a bunch of different ways to look at the vocal cords, but most commonly nowadays, most people use a little flexible laryngoscope. We take a look down at the vocal cords that diagnose those nodules. And then we start looking for maybe some common culprits that can cause those nodules. and they don’t always come from vocal abuse, but they most frequently do. And sometimes that abuse can be due to misuse. That misuse can be from chronic cough, or it can be from reflux creating vocal strain. And so we look for signs of things that might cause vocal strain. So if there is reflux, typically we wanna address the reflux component. If it is like a cough issue and someone’s having recurrent like asthma or… um, you know, cough related irritation to the vocal cords. We want to try to suppress that cough or treat that cough so that those vocal cords can, can heal. Cause frequently we start to use these extra laryngeal or outside the, the voice box muscles. And once we start to use those as Dr. Reddy was saying, these calluses form on either side of the cords. Once we start to use tension and we start to squeeze those vocal cords together, we really start to develop these kinds of calluses, much like you would on your hands from misuse or overuse. These calluses form from chronic repetitive inflammation in the irritation. And so trying to get that inflammation in the irritation down with reflux therapy, speech therapy is a very common thing that we’ll have patients do as well. Do you wanna speak a little bit more about what typically?

Dr. Reddy: Yeah, so with one option of speech or voice therapy, especially in our patients that are professional voice users, singers and musicians and public speakers for example, it’s not only how much you’re using your voice but how, the way that you’re, the quality of using your voice and that’s where a voice therapist can really teach you how to use your voice in a more effective manner where you’re not putting a lot of strain on your vocal cords. And so voice therapy can be helpful in a lot of our patients with vocal cord nodules. And if… know the conservative therapy doesn’t work which actually more than 90% of the times I would say if you do a combination of medication reflux management and voice therapy usually the vocal cord nodules slowly get smaller and go away with time but if they are persistent despite conservative therapy that’s when we sometimes go in there and do what’s called a video direct or the vocal cord nodule. Anything else to add?

Dr.  Smith: Yeah, I mean, one thing I would say is, sometimes vocal cord nodules can be a little bit tough to diagnose, so they don’t really look so clear on exam. Sometimes we need to do something called videostroboscopy, where we’ll actually take a look at those vocal cords cycling through a motion with a stroboscope, and that allows us to take a look at the different parts of the waveform of the vocal cords. and often they can become more apparent when you start to see different vibrating patterns in the anterior and posterior levels of the vocal cord. So evaluation I think is key for those treatment goals and treatment outcomes and making sure that patients and people understand that these might not be just a quick fix, this is not overnight and that’s really where a speech therapist really helps out kind of gold derived outcomes. And so like explaining that this isn’t going to be quick. It takes a lot of therapy and work on your own too, to try to get these things improved. I think we’ll talk about other causes of hoarseness in some upcoming podcasts, but we just wanted to talk about kind of the most common cause of hoarseness, but there are certainly, you know, some things that we’ll talk about that might be more concerning causes of hoarseness and some other like typical things that we do for hoarseness. As Dr. Reddy said, surgery is typically kind of like the last ditch effort for vocal cord nodules and almost, very rarely I should say, needs to be done. Can you think of any major concerns or complaints or problems that may arise with someone who has nodules, something that they might want to look out for or not do?

Dr. Reddy: Yeah, so the big red flags we look out for vocal cord nodules is that in… in some rare cases, it may not be an actual nodule and it may be something else. And so for anybody that has persistent hoarseness, that doesn’t get better despite treatment, or if their vocal cord nodule starts looking worse over time, that’s when we generally recommend just removing it and getting looking under a microscope and seeing what the actual nodule is made of. Because in rare cases, it can um be like a bad growth, like an early stage cancer. So that’s one thing that we worry about with this. But otherwise for most people, it’s just something that can be easily treated and managed. But I think that’s all we have for today for discussing vocal cord nodules. Stay tuned for more episodes, especially about hoarseness.

Dr. Smith: All right, take care guys.