Outlined below are three of the most common voice disorders. Other common voice disorders include vocal fold paralysis, reflux laryngitis, spasmodic dysphonia, laryngeal papilloma, bowing of the vocal folds, vocal fold granulomas, laryngeal cancer, laryngeal trauma, and vocal fold hemorrhage. The website www.WebMD.com is a wonderful resource for learning about the specific afflictions of the voice.
Vocal Fold Nodes or Nodules
These can be thought of as calluses of the vocal cords and are generally due to some form of trauma. The most common cause is voice abuse. In children they are often called “screamers nodes.” Other factors which seem correlated are poor vocal hygiene, such as excessive voice use or singing during a significant upper respiratory infection, or chronic coughing and throat clearing which may be due to other underlying medical conditions such as gastroesophageal reflux or asthma.
Vocal nodules are often broken down into soft and hard nodules or early and late nodules. If one likens vocal nodules to calluses on the hands, then soft or early nodules are like the calluses that a non-manual laborer gets after a weekend of gardening, whereas hard or late nodules are like the changes that occur on the hands of someone who performs heavy manual labor for many years. The nodules become essentially scars. The pathology in vocal nodules is confined to the surface covering of the vocal cord, where a thickening is seen which causes stiffness that interferes with vocal cord vibration, hence, the hoarse voice quality.
Surgery is typically avoided in the treatment of vocal cord nodules since the scarring which may result from removal of the nodule may interfere more with vocal cord motion than the nodule itself. Sometimes surgery is necessary for the most advanced vocal fold nodules, but this is quite rare. Voice rest or reduction in the amount of use, as well as learning proper use of the voice, are the mainstays of treatment. Typically speech / voice therapy is the treatment of choice. Any exacerbating underlying medical conditions must of course also be treated.
Vocal Fold Polyps/Reinke’s Edema
These again are usually traumatic or irritative in origin. Polyps are fleshier than nodules and not necessarily bilateral as are nodules. A single polyp may arise from a specific traumatic event. Reinke’s edema is a clinical term used to describe a common form of chronic laryngitis, wherein the entire covering of the vocal cords becomes polypoid and swollen. The condition is most often associated with irritation from tobacco smoke and/or alcohol. Gastroesophageal reflux is felt to play a causative role in many cases. These irritating substances are often coupled with some form of underlying voice abuse. The treatment is usually surgical excision, although occasionally a small polyp may respond to voice therapy. It is essential that the underlying irritating condition be treated or stopped, or the chronic laryngitis will return.
Vocal Fold Cysts
The exact cause of vocal cord cysts is unknown. They may be congenital, or may result when a damaged area of the vocal cord heals. In this case the pathology is just under the surface of the vocal cord. Special surgical techniques which remove the cyst from the vocal cord while keeping trauma to the overlying surface of the vocal cord at a minimum are used to remove cysts.