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February 21, 2024.

Vocal cord nodules refers to the vocal cord injury and scar formation caused by prolonged or excessive use of the vocal cords, resulting in hoarseness of the voice.

During the Lunar New Year, celebrations, smoking, drinking alcohol, combined with inadequate throat care on regular days, can potentially lead to vocal cord lesions.

On festive occasions, it is advisable to control oneself appropriately and avoid overexertion to prevent damage to the vocal cords.

The vocal cord is the main component of the vocal organ, composed of muscles, ligaments, and mucosal epithelium. Its main function is to vibrate to produce sound. When we speak, sing, or use our voice, we rely on the vocal cord and other related organs to produce sound.

Many people have this experience: after singing loudly and enthusiastically at karaoke with friends the night before, or cheering loudly at festive occasions, the next day their voices become hoarse or they come close to losing their voice.

Just like during Chinese New Year, when people celebrate the festival;
excessive excitement during celebrations, staying up all night chatting with friends, excessive alcohol consumption, and smoking can all contribute to making our voices hoarse.

Loss or change of voice but no sore throat

Moreover, in cases of prolonged and excessive use of the voice, combined with other factors such as inadequate protection of the vocal cords, significantly increases the risk of developing vocal cord lesions.

One common condition is vocal cord nodules, or what is commonly known as vocal cord calluses. Vocal nodule refers to a lesion in the vocal cords, where the anterior surface layer, the lamina propria, forms scars, causing abnormal symptoms.

The most obvious symptom is hoarse voice, and some may experience loss of voice or changes in sound. This condition does not cause sore throat or difficulty breathing. It often occurs at the junction of the front one-third and back two-thirds of the vocal cords, much like a crossroad. When the vocal cords vibrate, this area experiences the most friction.

Prolonged improper friction causes swelling (edema) of the epithelium and hardening, forming scar tissue, which appears as nodules or symmetric white hard lumps, resembling a pair of twins.

In Malaysia, about 1% of people suffer from vocal cord nodules. As mentioned earlier, prolonged or excessive use of the voice can cause damage to the vocal cords. Vocal cord nodules are mainly caused by vocal abuse or misuse.

This condition is more likely to occur in people who need to use their voices extensively, such as those who shout for long periods or speak continuously.

Some professions require extensive use of the voice, such as singers, teachers, and salespersons. Vocal cord nodules in singers are referred to as singer nodules, while those in teachers are called teacher nodules.

In addition, people who stay in noisy environments for a long time and need to raise their voices or shout, such as vendors in markets or children who often scream, are also at risk of developing vocal cord nodules. Excessive use of the voice during festivals is also one of the risk factors for vocal cord nodules.

Long term acute laryngitis to nodules

Vocal cord nodules develop slowly over time. The groups of people mentioned above typically develop this condition over the years.

I’d like to remind the public that excessive or improper use of the vocal cords can cause inflammation and redness, which is the initial stage of acute laryngitis, and eventually result in the formation of nodules.

Vocal cord nodules do not progress into cancer. It is a benign condition that the public does not need to worry about.

As mentioned earlier, nodules are like a pair of ‘twins’, with lesions mostly located at the front. If the lesion appears solely on one side, there is a possibility it may be related to cancer, and it should not be dismissed.

Flexible laryngoscopy to examine the vocal cords

When hoarseness occurs and persists despite trying some methods for a period of time, it is advisable to seek medical attention immediately.

When diagnosing nodules, doctors can initially evaluate the likelihood based on clinical inquiries, including the patient’s medical history and symptoms, such as voice quality.

Next, the doctor performs a flexible laryngoscopy on the patient. A soft and thin tube is inserted into a nostril, passing through the throat, and reaches the larynx to examine the vocal cords. This thin tube is equipped with special lighting and cameras to capture images of the vocal cords, allowing for the detection of any abnormalities.

98% do not require medication or surgery

After confirming the diagnosis, most patients (about 98%) do not need any medication or surgical treatment.

Following the doctor’s advice, in most cases, the condition can heal on its own. However, some patients may experience discomfort in the throat due to acid reflux and may need to take relevant medications.

It must be mentioned that if hoarseness occurs without extensive use of the voice, it may indicate other conditions such as pharyngitis. Unlike vocal cord nodules, pharyngitis is characterized by redness and swelling of the vocal cords, sore throat, and sometimes fever.

Starting with 4 non-drug treatments

In terms of treatment, it is best to start with non-drug interventions.

Firstly, allow the vocal cords to rest and stop behaviors that cause vocal cord diseases.

Patients should speak as little as possible, speak softly, control their volume, speak slowly, and avoid shouting.

Secondly, avoid consuming foods that can cause discomfort in the throat, such as spicy, greasy, and sour foods.

Thirdly, quit smoking and reduce alcohol intake.

Fourthly, drink plenty of water, especially for those who work for long periods in air-conditioned environments, as the throat may become dry, drinking water can keep the throat moist.

Earlier, I reminded patients to speak gently to protect their vocal cords.

I want to emphasize that speaking gently does not mean whispering or speaking in a hushed tone.

Whispering primarily relies on the vibration of the front two-thirds of the vocal cords, which can actually cause significant damage to the vocal cords.

Therefore, it’s important to speak gently in a normal tone, avoiding whispering or speaking softly.

Furthermore, as previously stated, certain professions, such as teaching, entail speaking loudly. I acknowledge the challenges of teaching, that even if one’s voice is hoarse, taking time off and resting at home may not be feasible.

Hence, I recommend that teachers use amplifiers during teaching sessions to reduce the need for loud speech and protect their vocal cords.

Speech therapy and vocal hygiene for at least 6 weeks

Other than seeking medical attention from an otolaryngologist (ENT specialist), patients can receive treatment from a speech therapist through referral from their attending doctors. Through speech and language therapy (SLT), which focuses on non-drug treatments, patients can achieve certain medical effects.

Speech therapists mainly teach patients vocal hygiene information, including how to rest their voice, how to care for their vocal cords, how to speak correctly, and adjustments and corrections in diet and behavior.

Microlaryngeal surgery to remove nodules

The above two treatment plans need to be maintained for at least 6 weeks, or even 12 weeks, to be effective.

Generally, vocal nodules will resolve on their own. However, if proper care and speech therapy are ineffective and have been attempted for at least six months, microlaryngeal surgery (phonomicrosurgery) may be considered to remove the nodules.

During the surgery, the surgeon inserts a laryngoscope directly into the patient’s mouth to reach the lesion. The white nodules can be clearly seen from the imaging and removed. The process only takes one hour. The patient can be discharged from the hospital on the same day after the operation and return home to recuperate.

This surgery carries certain risks, and there is a possibility of experiencing postoperative complications.

A notable example is Julie Andrews, the renowned actress who portrayed the lead role in the musical and film “The Sound of Music.” She suffered permanent damage to her voice, losing four octaves of her soprano range, following a vocal cord nodule removal surgery.

Try to avoid surgery as much as possible

In fact, the possibility of vocal cord nodule removal surgery is extremely low. If necessary, it is recommended to consult with otolaryngologists (ENT specialist) who specialize in vocal cord surgery.

However, these specialists are rare in our country.

Personally, I believe that it is best to avoid surgery as much as possible and treat this condition with voice rest, unless absolutely necessary.

If left untreated, the nodules will become thicker and harder, and your voice will become permanently hoarse.

On the other hand, Chinese New Year is a festive occasion, and celebrations are inevitably joyous. However, I want to remind the public to celebrate in moderation to avoid causing damage to the vocal cords.

**Friendly reminder: References to products, services, and individual cases in this article or advertisement are for informational purposes only and should not be used as a basis for diagnosis. Always rely on the advice of a medical professional.

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