Vocal Nodules – an unusual case study

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Vocal Nodules – an unusual case study

Vocal nodules and the speech pathologist

Treating patients with vocal nodules, is one of the most common conditions a Speech Pathologist working with voice disorders will see. I’ve treated dozens of people who have vocal nodules. They are always female; they are sometimes smokers and social drinkers (‘party’ people), sometimes teachers, sometimes singers etc. I’d never treated a male with vocal nodules, until I was referred this one.

Vocal nodules – the unusual patient

The patient on the ENT examination that looked at his vocal folds (who we will call D for confidentiality purposes), had the biggest vocal fold nodules (vocal nodules) that both myself and the ENT had ever seen. He first came to me when he was 18 years old and just before his HSC exams. Both the ENT and I thought that therapy would potentially reduce D’s vocal nodules, but that they were far too large to be completely eradicated. In his initial appointment, he presented with a severely hoarse voice that was very unstable and very difficult to understand at times. He also completely lost his voice on occasion. He reported that he first noticed voice changes a year before seeing me and attributed the changes to partying and talking/yelling in noisy environments (such as nightclubs, pubs with loud bands etc.) when he was drunk. He was smoking nearly a pack a day for at least a year. He stopped that after seeing the ENT. He also had a very loud voice when talking to me in conversation. When I asked him about whether he thought he spoke loudly in conversations, he admitted that he’d always had feedback from others that he appeared to be yelling when talking but didn’t realise that he was talking so loudly (i.e. poor self perception).  He also smoked marijuana throughout the year. D had recently ceased that too but was planning to recommence smoking joints when he went to Byron Bay for a holiday. I strongly advised against him doing so. In later appointments, D had just finished his HSC and was going out most nights, drinking alcohol. He reported often feeling strain in his voice throughout the day and feeling as though he had to force it to get it out. At that http://healthsavy.com time he had just commenced taking the medication that the ENT prescribed (months beforehand at his initial assessment) for possible underlying Laryngopharyngeal reflux (LPR- see previous posts for more information).

Vocal nodules – the treatment

I devised a voice therapy program for D as well as making behavioral and lifestyle change recommendations. D was hoping to get into a Law course at university and become a Barrister. If he was accepted into the course, his voice would be an essential element for him to have successful career. I saw D for approximately 6 sessions and he worked extremely hard at his therapy in the sessions and at home, as well as incorporating the other changes that were recommended. At the last therapy session, D presented with what sounded like a completely normal voice. He was reviewed by the ENT who performed a repeat examination and D’s vocal nodules were nearly completely gone- there was only slight swelling at the point on both vocal folds where the nodules had been. D got into Law at university and the last time I spoke to him, he had maintained a normal voice for at least a year.

Vocal nodules – what to do

It is extremely important at the first sign of any changes in your voice to have an examination by an ENT. It is mostly likely something benign (not cancer) like vocal nodules, or it could be something more sinister (like cancer). It’s always worthwhile to get things checked out. If you use your voice professionally (e.g. teachers, singers, lawyers, telephone operators, etc), if you have a ‘big’ personality and are the life of the party, if you come from a ‘loud’ family where everyone yells when conversing etc (in other words, if you use your voice a lot) and you notice changes in your voice – you may have vocal nodules. The earlier you come in for assessment and treatment, the more easily they can be treated/eliminated. The longer you leave it, the more difficult they are to get rid of. Call ‘Sydney Voice and Swallowing’ if you think you may have vocal nodules.

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