The Medical Consumer's Advocate

Nodules! Polyps! Two diagnoses in one! (NOT.)

 

The writer reports progressive hoarseness over the preceding 7 months. Her ENT reported that she had "two small nodules, or polyps," on her vocal cords. The ENT blamed it on bad voice habits and allergies, prescribed a nasal steroid spray, and referred her to a speech therapist.

A: It worries me that your ENT said you had "two small nodules, or polyps." Nodules and polyps are two very different animals. If your ENT does not know the difference between these two diagnoses, he may not be recommending the best treatment for you.

Let’s examine each diagnosis separately. Vocal nodules are also known as "screamer’s nodules" or "singer’s nodules." That should give you a fairly clear picture of what causes nodules: vocal abuse. The fact that most professional singers do not develop nodules has much to do with the fact such individuals usually have been taught how to use (and not abuse) their voice. Children, adults who often scream at their children, and nonprofessional singers are much more likely to develop nodules.

Nodules do not respond to surgical treatment but do respond to speech therapy. Your allergies may be contributing to the problem, but it is more likely that you misuse your voice. Poor hydration (drinking too many caffeinated or alcoholic beverages and not enough water or juice) is another common contributing factor.

Vocal polyps are fleshy appendages that hang off the vocal cords like water bags. They are usually caused by chronic inflammation of the vocal cords. Once again, allergies or chronic sinusitis may contribute to formation of vocal polyps, but more common culprits are cigarette smoke and/or chronic reflux. (Reflux occurs when stomach acids and digestive enzymes ascend the esophagus and spill over into the throat, often burning the vocal cords.) Unlike vocal nodules, polyps are best treated by surgical removal AND correction of the underlying problem (stop smoking, treat the reflux, etc.)

These conditions are best diagnosed by having an ENT examine your vocal cords using a fiberoptic camera (or endoscope.) Use of a stroboscopic light source is often helpful, as it enables the doctor to view the vocal cords in a faux slow motion. Many ENTs are very good at examining the vocal cords using a small mirror placed in the back of the throat, but in my opinion this diagnosis is best made with the aid of fiberoptic scopes.

To learn more about these conditions, you might want to visit the Center for Voice Disorders website, or The Voice Center ( There’s a great photo of vocal nodules right at the top of the Center for Voice Disorders homepage!)

 

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