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Treatment

Rather than surgery...therapy!

According to Pederson et al. (2005), “It may be that ‘failures’ of therapy will also fail all types of intervention. Even if the nodules are removed, if the causative factors are not addressed, the nodules will recur.”

Facilitating Approaches:

confidential voice, counseling, focus, glottal fry, nasal/glide stimulation, and yawn-sigh

Vocal Hygiene:

breathing, onset, dietary concerns, environmental concerns, and hydration

Signs and Symptoms

  • hoarse or breathy vocal quality
  • soreness or pain which may also radiate to other areas
  • lower voice pitch
  • increase in aperiodicity
  • difficulty producing pitches in the upper third of the singing range
  • reduced phonational (pitch) and dynamic (loudness) range

Vocal Fold Nodules in Adults

Assessment Continued

My Experience...

  • subjective rating by the patient
  • Voice Handicap Index (VHI)
  • Voice-Related Quality of Life Measure (V-RQOL)
  • perceptual voice evaluation by the clinician
  • Roughness-Breathiness-Hoarseness Scale (RBH)
  • Grade-Instability-Roughness-Breathiness-Asthenia-Strain Scale (GBRAS)
  • acoustics
  • fundamental frequency, intensity, perturbation, sound spectrography, and signal-to-noise ratio
  • videostroboscopy/vibration analysis of the vocal folds
  • aerodynamics
  • lung volumes and capacities, air pressure, airflow, laryngeal resistance, and durational measures
  • My background
  • Diagnosis/treatment
  • vocal rest, voice instruction (from a choir director)
  • used focus technique, breath support, hygiene

Definition

Vocal Fold Nodules

Assessment

  • The most common benign lesions of the vocal folds
  • Typically found bilaterally on the glottal margin of the vocal folds at the juncture of the anterior and middle third of the vocal fold (Why?)
  • Result from cellular damage to the basement membrane zone of the vocal fold, which connects the outer epithelial layer to the lamina propria of the vocal folds
  • Most common in women ages 20-50 (Theories?)

A Functional Voice Disorder

References

Bohlender, J. (2013). Diagnostic and therapeutic pitfalls in benign vocal fold diseases. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 12, Doc01. DOI: 10.3205/cto000093

Boone, D., McFarlane, S., Von Berg, S., & Zraick, R. (2010). The Voice and Voice Therapy (Eighth ed., pp. 197, 198, 207, 211, 212-213, 223-224, 243). Boston, MA: Allyn and Bacon.

Colton, R., & Casper, J. (2011). Understanding voice problems: A physiological perspective for diagnosis and treatment (Fourth ed., pp. 98-101). Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.


Pedersen M, McGlashan J. Surgical versus non-surgical interventions for vocal cord nodules. The Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD001934. DOI: 10.1002/14651858.CD001934.

Sivasankar, M., & Leydon, C. (2010). The role of hydration in vocal fold physiology. Current Opinion in Otolaryngology & Head and Neck Surgery, 18(3), 171–175. DOI:10.1097/ MOO.0b013e3283393784

Sheela, S. (n.d.). Laryngeal aerodynamic analysis of vocal nodules. Journal of Laryngology and Voice J Laryngol Voice, 10-10. Retrieved June 10, 2015, from www.laryngologyandvoice.orgarticle.aspissn=2230-9748

Images taken from: http://jslhr.pubs.asha.org/article.aspx?articleid=1851192

and http://www.practicalslpinfo.com/evaluating-reflux.html

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