Vocal cord nodules

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Classification according to ICD-10
J38.2 Vocal cord nodules
ICD-10 online (WHO version 2019)

As a vocal cord nodules or vocal cord nodules , often singers or cry nodules called, is known more or less symmetrical elevations on the edge of the vocal folds , similar to the cornea on the skin. These lead to a disruption of the vibration process of the vocal fold mucosa and a disruption of the vocal fold closure. Vocal cord nodules caused by permanent overload of voice or un physiological vocal technique (hyper functional dysphonia ).

causes

As the popular name suggests, an overload of the vocal apparatus can lead to permanent changes at the edge of the vocal folds. Typically, the nodules appear at the transition from the anterior to the middle third of the vocal folds. It is believed that at this point to a vibration node formation of the amplitudes, which run over the Stimmlippenmucosa comes and thereby an increased load occurs at this predilection site. After only briefly overloading the voice, the laryngoscopic image shows a slight edema of the mucous membrane, which regresses again after the voice is spared. With unchanged exposure, the edema increases, with stroboscopicIn the analysis, however, amplitudes and marginal edge shifts can still be recognized, but reduced at the affected area (see also myoelastic-aerodynamic process ). This condition is referred to as a phonation thickening in the initial findings , and as a soft nodule when it is more pronounced . With increasing time and load, the connective tissue remodeling progresses, the hard nodule develops. In the stroboscopic analysis, the amplitudes are then canceled there.

In the case of larger nodules, the image of the so-called hourglass glottis arises, as the vocal folds only come into contact in the area of ​​the nodules, but a gap remains in the anterior and posterior third.

therapy

The edema usually resolves spontaneously while the voice is gentle. For soft nodules, voice therapy to learn the physiological use of voice with eutonic vocalization (i.e. with normal muscle tension) is the therapy of first choice. Hard nodules do not regress through voice therapy because of the connective tissue remodeling; they must be removed phonosurgery (surgically). Sandwich therapy is useful, i. H. Before the operation, a short voice therapy to learn some principles, then postoperatively further development of the physiological use of the voice.

In children ( screaming nodules ), voice therapy is problematic due to a lack of participation (age-dependent), and educational influence to avoid screaming is more successful. Very often the nodules regress as part of the mutation .

literature

  • Jürgen Wendler, Wolfgang Seidner, Ulrich Eysholdt: Textbook of Phoniatry and Pedaudiology . 4th edition. Thieme-Verlag, Stuttgart 2005, ISBN 3-13-102294-9 .
  • Richard Luchsinger, Gottfried Arnold: Handbook of voice and speech medicine. 2 volumes. 3. Edition. Springer-Verlag, Vienna / New York 1970, DNB 457462922 .