Vocal Nodes and Polyps: A Pain in the Neck

Disorders of the voice are among the most prevalent problems in the US that fall under the umbrella of speech-language pathology.  According to one study, the lifetime prevalence of voice disorders is nearly 30% (1).  Studies trying to pinpoint general voice problems among adults vary, but it is estimated that 5-10% of the workforce would be classified as heavy occupational voice users (2).  These occupations include careers such as teachers, flight attendants, salespeople, customer service, coaches, and many other jobs.  Approximately 28 million working Americans say they experience daily voice problems.  These problems can range from soreness to loss of voice, coughing, hoarseness, and impaired voice quality.  Some voice disorders, such as functional and spasmodic dysphonia along with voice disorders secondary to another pathology, are not directly related to vocal over- or misuse.  However, vocal overuse and misuse can lead to a host of problems in and of themselves.

Vocal polyps can take a number of forms, and are sometimes caused by vocal misuse.  They may look like a small reddish bump or swelling on one or both sides of the vocal folds, a stalk-like growth, or a blister-like lesion.  Most polyps are larger than nodules (which will be covered later), and they can be called by a number of names.  The best way to think about vocal polyps, is that they're like blisters on your vocal folds.

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Vocal nodules, on the other hand, are benign (meaning non-cancerous) growths on one or both sides of the vocal folds (also called vocal cords).  They are relatively hard and usually positioned on the area of the vocal folds that receives the most use.  They are equivalent to callouses on your vocal folds.  Over time, when repeated misuse of the vocal folds occurs, these callouses form (often starting as blister-like growths or polyps) and grow into the harder callous-like bumps as misuse continues.  So long as the vocal misuse continues, the nodules will continue to get larger and harder.  Since they took longer to form, vocal nodules are harder to manage and get rid of.

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While many people experience at least occasional vocal problems, there are risk factors that make you more susceptible to developing things like polyps or nodes.  

The signs and symptoms of vocal polyps and nodes are similar, and include:

• hoarseness
• breathiness (think Marilyn Monroe voice, only not on purpose)
• a "rough" or "scratchy" voice (Clint Eastwood)
• harsh voice
• shooting pain from one ear to another
• neck pain
• voice fatigue or loss of voice
• decreased pitch range
• a "lump in the throat" sensation

I don't want you to look at the above list and immediately run to an ENT.  Many of these symptoms can be caused by other things too.  However, if these symptoms persist outside for more than two weeks outside of a cold it's a good idea to get checked out.

While most of us still have to use our voices as a big part of our jobs (myself included), there are several things we can do to minimize the risk of developing voice problems.

1. Use amplification whenever possible if you're going to be talking in a noisy environment or to a large group of people.  Yelling is a very common form of vocal misuse.
2. Manage your allergies and minimize throat clearing.  That harsh noise you produce when you clear your throat with a cough is your vocal cords slamming together.  
3. Stop smoking, or switch to e-cigarettes.  While e-cigarettes won't cure your nicotine addiction, you aren't inhaling smoke and tar into your lungs (and past your vocal cords), which will help you reduce coughing and throat clearing.
4. Use an appropriate and natural voice.  One of the reasons I work with transgender women is that there is potential for lots of problems when trying to change your habitual pitch, and it's important for your vocal health and your presentation to adjust your pitch and voice safely.
5. Hydrate!  Drink water throughout your day.  Minimize alcohol and caffeine intake, and continue to drink water while you drink alcohol. 
6. Take a period of vocal rest, especially if your throat is feeling raw or scratchy.  If you nip voice issues in the bud, they will be able to resolve before turning into polyps or nodules.

So, if you use your voice a lot throughout the day, make sure you're caring for it.  If you regularly get the scratchy or raw voice feeling, it may be that you're engaging in some vocal misuse.  Getting checked out by an ENT and/or having a consult with a speech pathologist wouldn't go amiss.  

Good vocal health everybody!

References

1. Roy, N., Merrill, R.N., Gray, S.D., & Smith, E.M. (2005, November). Voice disorders in the general population: Prevalence, risk factors, and occupational impact. Laryngoscope, 115 (11): 1988-1995.

2. Roy, N., Weinrich, B., Gray, S.D., et al. (2003, June). Three treatments for teachers with voice disorders: A randomized clinical trial. Journal of Speech, Language, and Hearing Research, 46, 670-688.

3. Verdolini, K., & Ramig, L.O. (2001). Review: occupational risks for voice problems. Logopedics, Phoniatrics, Vocology, 26 (1): 37-46.