Editing Vocal cord nodule (section)

{{Short description|Benign white growths on vocal folds which change one's voice quality}}
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| name            = Vocal voice nodule
| synonyms        = '''Vocal fold nodules''', '''Vocal nodules'''
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'''Vocal cord nodules''' are bilaterally symmetrical [[Benignity|benign]] white masses ([[Nodule (medicine)|nodules]])  that form at the midpoint of the [[Vocal cords|vocal folds]].<ref name="Verdolini et al 2014 Vocal Fold Nodules">{{cite book |editor1-first=Katherine |editor1-last=Verdolini |editor2-first=Clark A. |editor2-last=Rosen |editor3-first=Ryan C. |editor3-last=Branski |year=2014 |chapter=Vocal Fold Nodules (Nodes, Singer's Nodes, Screamer's Nodes |chapter-url={{Google books|H8x4AgAAQBAJ|page=37|plainurl=yes}} |pages=37–40 |title=Classification Manual for Voice Disorders-I |publisher=Psychology Press |isbn=978-1-135-60020-4 }}</ref> Although diagnosis involves a [[physical examination]] of the [[head]] and [[neck]], as well as perceptual voice measures, visualization of the vocal nodules via laryngeal [[endoscopy]] remains the primary diagnostic method.<ref name=pmid14631179>{{cite journal |last1=Johns |first1=Michael M. |title=Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |volume=11 |issue=6 |pages=456–61 |year=2003 |pmid=14631179 |doi=10.1097/00020840-200312000-00009|s2cid=45661781 }}</ref><ref>{{cite journal |last1=Pedersen |first1=Mette |last2=McGlashan |first2=Julian |last3=Pedersen |first3=Mette |title=Surgical versus non-surgical interventions for vocal cord nodules |journal=The Cochrane Database of Systematic Reviews |issue=6 |pages=CD001934 |year=2012 |volume=2012 |pmid=22696326 |doi=10.1002/14651858.CD001934.pub2 |pmc=7064879 }}</ref> 

Vocal fold nodules interfere with the vibratory characteristics of the vocal folds by increasing the [[mass]] of the vocal folds and changing the configuration of the vocal fold closure pattern.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="pmid14631179" /><ref name="Colton et al 2006 Nodules">{{cite book |last1=Colton |first1=Raymond H. |last2=Casper |first2=Janina K. |last3=Leonard |first3=Rebecca |year=2006 |chapter=Nodules |chapter-url={{Google books|1RwVcsw0KLAC|page=100|plainurl=yes}} |pages=100–4 |title=Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-4239-9 }}</ref> Due to these changes, the quality of the voice may be affected.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /> As such, the major perceptual signs of vocal fold nodules include vocal [[hoarseness]] and breathiness.<ref name="Colton et al 2006 Nodules" /><ref name="pmid19779347">{{cite journal |last1=Kunduk |first1=Melda |last2=McWhorter |first2=Andrew J |title=True vocal fold nodules: the role of differential diagnosis |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |volume=17 |issue=6 |pages=449–52 |year=2009 |pmid=19779347 |doi=10.1097/MOO.0b013e3283328b6d |s2cid=8834120 }}</ref> Other common symptoms include vocal fatigue, soreness or pain lateral to the [[larynx]], and reduced frequency and intensity range.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="Colton et al 2006 Nodules" /><ref name="pmid19779347" /> Airflow levels during speech may also be increased.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /> Vocal fold nodules are thought to be the result of vocal fold tissue trauma caused by excessive mechanical stress, including repeated or chronic vocal overuse, abuse, or misuse.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="pmid14631179" /><ref name="pmid19779347" /> Predisposing factors include profession, gender, dehydration, respiratory infection, and other inflammatory factors.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="pmid14631179" />

For professional voice users as well as individuals who frequently experience [[Dysphonia|hoarseness]], vocal hygiene practices are recommended for the prevention of vocal fold nodules and other voice disorders.<ref name=pmid19741535>{{cite journal |last1=Leonard |first1=Rebecca |title=Voice therapy and vocal nodules in adults |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |volume=17 |issue=6 |pages=453–7 |year=2009 |pmid=19741535 |doi=10.1097/MOO.0b013e3283317fd2 |s2cid=42269683 }}</ref> Vocal hygiene practices include three components: regulating the quantity and quality of voice use, improving vocal fold hydration, and reducing behaviours that jeopardize vocal health.<ref name=pmid19741535/> About 10% of nodules resolve on their own, which is more likely if they are smaller and the onset more recent.<ref name="Simpson & Rosen 2008 Vocal Fold Nodules">{{cite book |first1=Blake |last1=Simpson |first2=Clark |last2=Rosen |chapter=Vocal Fold Nodules |pages=105–7 |doi=10.1007/978-3-540-68107-6_16 |year=2008 |title=Operative Techniques in Laryngology |publisher=Springer |isbn=978-3-540-25806-3 |s2cid=234161002 }}</ref> Treatment of vocal fold nodules usually involves behavioural intervention therapy administered by a [[speech-language pathology|speech–language pathologist]]. In severe cases, [[surgery]] to remove the [[lesion]]s is recommended for best [[prognosis]].<ref>{{cite journal |last1=Béquignon |first1=Emilie |last2=Bach |first2=Christine |last3=Fugain |first3=Claude |last4=Guilleré |first4=Lia |last5=Blumen |first5=Marc |last6=Chabolle |first6=Frédéric |last7=Wagner |first7=Isabelle |title=Long-term results of surgical treatment of vocal fold nodules |journal=The Laryngoscope |volume=123 |issue=8 |pages=1926–30 |year=2013 |pmid=23757348 |doi=10.1002/lary.23768 |s2cid=36758075 }}</ref><ref>{{cite journal |last1=Nakagawa |first1=Hideki |last2=Miyamoto |first2=Makoto |last3=Kusuyama |first3=Toshiyuki |last4=Mori |first4=Yuko |last5=Fukuda |first5=Hiroyuki |title=Resolution of Vocal Fold Polyps With Conservative Treatment |journal=Journal of Voice |volume=26 |issue=3 |pages=e107–10 |year=2012 |pmid=22082864 |doi=10.1016/j.jvoice.2011.07.005 }}</ref> In children, vocal fold nodules are more common in males; in adults, they are more common in females.<ref name=pmid2199731>{{cite journal |last1=Dobres |first1=Rachel |last2=Lee |first2=Linda |last3=Stemple |first3=Joseph C. |last4=Kummer |first4=Ann W. |last5=Kretschmer |first5=Laura W. |title=Description of Laryngeal Pathologies in Children Evaluated by Otolaryngologists |journal=Journal of Speech and Hearing Disorders |volume=55 |issue=3 |pages=526–32 |year=1990 |pmid=2199731 |doi=10.1044/jshd.5503.526 }}</ref><ref name="pmid19779347" />