Vocal Nodules | Singer's Nodes

Every one prefers heart like iron and throat as brass. Anyhow, overuse or abuse can bring problems and Vocal cords are no way exception. Nature warns initially by hoarseness of voice about the overuse or abuse of voice. Even then, if proper care is neglected, vocal nodules come as penalty.

Vocal nodule is the crown of hoarseness disorders. It is otherwise called as Singer’s nodes or Teacher’s nodes, as they are common with them due to continuous use of voice. Vocal nodules are small, benign (non cancerous), hard, bead like fibroid formations that crop up on the vocal cords mostly because of misused voice or uncared laryngitis. It is not an acute ailment, but a slowly progressing chronic complaint. So, one needs to opt treatment at the earliest to arrest its progress. Vocal nodule patients need to maintain peace to lead a peaceful life!

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INCIDENCES - The incidences of vocal nodules are more prevalent in females than in males. The reason is unknown. It is common in adults, but can occur in children too. Also, the occurrences of vocal nodules are more common in singers / teachers / public speakers especially after a voice abuse or over strain. Vocal nodules usually occur on both the sides (i.e. bilaterally) especially in the junction of anterior one third and posterior two thirds.

PATHOLOGY - Vocal cord plays the voice / sound. Vibration of vocal cords usually allows air from lungs then and there, according to need of expected sound that has to be produced. While any one attempt to strain with speaking or singing, when there is infection or odema, vocal cords may get rubbed hard against each other to get pressure abrasions or injury. This friction occurred with vibration of vocal cord usually causes scratchy, hoarse voice and pain.

Uncared and constant or recurrent abrasions usually get healed with formation of stronger epithelial cells, i.e., small bead like vocal nodules. This thickening or formation of node is a protective reaction to safeguard the parts to prevent further injury. For example- in the hands of farmers or rowers, the thickening of skin is formed at the base of the fingers and feet to prevent blister formation during frictions.

CAUSES – Vocal nodule commonly occurs after repeated voice strain (speaking / singing loudly, shouting, screaming, laughing, crying, etc) which use to injure vocal cord repeatedly. The other triggers which cause vocal nodules to get injured commonly are recurrent laryngitis (sore throat), tonsillitis, adenoids, sinusitis, post nasal drip, violent cough / sneeze, oesophageal gastric reflux (acidity), etc. It may also be from chewing peppermint continuously, inhaling mosquito repellents and nasal decongestants too.

SYMPTOMS – In case of vocal nodules, voices may be low pitched, creaky, scratchy, hoarse & husky. Further, there may be

Tickling sensation in the throat
Sensation of foreign material in the throat
Voice struck in the throat / inability to produce expected clear sounds
Fleeting sound while straining to make high pitched sound
Induction of cough with difficulty in breathing (occasionally)
Unless otherwise vocal nodules are properly cared, it will sustain or increase the intensity of the hoarseness in course of time to mute the voice totally.

DIAGNOSIS AND INVESTIGATIONS – To diagnose vocal nodule initially, examination of the deep throat using laryngeal mirror can help. Laryngoscope can aid in better way to visualise vocal cords clearly and to state the lesion as nodule, cyst, polyp, etc with their differentiating features. Laryngoscope can also help to do biopsy to rule out cancer throat and to do excision of nodes.

Vocal nodules are usually differentiated from Vocal polyp (Reinke's edema) by its hardness, bilateral occurrences and site of formation (i.e., at the junction of anterior one third with posterior two thirds). The vocal polyps are very soft and can occur as single in various places. Biopsy can further confirm the lesion as nodule or polyp by the covering membrane. A nodule has epithelium as its covering whereas polyp has mucous membrane as covering.

PREVENTION & MANAGEMENT – In case of having vocal nodule, following care and management will be very helpful to provide comfort to the throat.

Do’s

• Use voice slowly and properly

• Give voice rest as much as possible till hoarseness get resolved

• Take lukewarm water often to maintain moisture of throat. Further warm drinks and warm application can soothe the throat pain (if any)

• Take care for room humidity

Avoid

• Shouting / crying / speaking loudly and continuously (overusing voice)

• Doing mimicry or whispering (misusing voice)

• Clearing throat & spitting often

• Mouth breathing

• Nasal decongestants and unnecessary drugs (since even pain killers, diuretics, anti depressants, anti histamines, birth control pills, sedative drugs, etc can cause dryness which may lead to more abrasions in vocal nodules while speaking)

• Preservative added foods / drinks / fast foods / allergic substances and other known hoarseness triggers like ice creams, cool drinks, chocolates, fruits, etc.

• Inhaling chemical fumes / smoke / pollutants

• Tobacco chewing / smoking / alcohol / drugs

• Spicy, hot and acid foods

GENERAL TREATMENT – In general, for hoarseness, every one use to ignore treatment / management initially, since most of the time, hoarseness of voice will go off on its own (shortly or in course of time). But with negligence or when left untreated, hoarseness may sustain to annoy the sufferer continuously and later get healed hard to form vocal nodules. At the least, in this stage one need to care for vocal nodule and to follow precautions strictly or otherwise it can even mute one’s voice.
Allopathy treats vocal nodule as a surgical complaint and usually recommend surgical option to get rid off it. Any how, if it is small, patients will be put on a course of antibiotics and painkillers with the advice of voice rest and speech therapy for a course of time to check whether vocal nodule is coming down automatically or not. If it is not coming down, surgery will be advised as a last resort to clip off the nodule. If vocal nodule is big, then excision will be advised straight away.

HOMEOPATHIC APPROACH ON VOCAL NODULES – Homeopathy is more effective than any other system of medicines in clearing vocal nodules or polyps. Homeopathic treatment can do wonders by removing disease completely (if treatment is started at the earliest and vocal nodule is not so big) or can provide dramatic relief by shrinking nodules (if it is big).

Regarding homeopathic treatment, homeopathy gives importance to the individual symptoms / patient’s feelings with respect to disease than for the disease symptoms itself. Symptom presentations may also differ from person to person depending upon the cause and intensity. For some, there will be betterment on continuous use of voice (better in evening than in morning). For some, it may get worsened with usage (better in morning and worst in evening) and for some others, clearing the throat can give some relief. Homeopathy stands here with individualization to treat the disease / tendency at its root level by strengthening our vital force. Homeopathy can be considered as a tremendous breakthrough to combat it surgically. Homeopathy can also switch off the hoarseness smoothly and effectively at the earliest. Even though, its process may not be incidental, it provides recovery in slow phase in a permanent manner.

Homeopathic medicines commonly used in cases of vocal nodules are Ammon caust, Apis, Arg met, Arnica, Arum triphyllum, Belladonna, Borax, Bromium, Calc carb, Carbo veg, Causticum, Chamomilla, Drosera, Ferrum picricum, Hepa sulf, Hyosyamus, Iodium, Kali bich, Kali Iod, Kali mur, Lachesis, Lycopodium, Mag carb, Merc bin iod, Merc sol, Natrum mur, Nitric acid, Phosphorus, Phytolacco, Pulsatilla, Rhus tox, Rumex, Ruta, Silicea, Sulphur, Thuja, Zinc met, etc, These medicines should be taken under the advice and diagnosis of a Qualified Homeopath.