Vocal cord nodule
[1] 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.[4][5] Other common symptoms include vocal fatigue, soreness or pain lateral to the larynx, and reduced frequency and intensity range.[1][5] There may be a sensation of soreness or pain in the neck, lateral to the larynx,[1][4] which generally occurs because of the increased effort needed to produce the voice.[1] Major acoustic signs of vocal fold nodules involve changes in the frequency and the intensity of the voice.[2] This stress is thought to reach its maximum in the mid-membranous region of the vocal folds, at the junction of the anterior 1/3rd and posterior 2/3rd, the most common site of nodule formation.Activities or professions that may contribute to phonotraumatic behaviors include cheerleading, untrained singing, speaking above noise, and teaching without voice amplification, as these increase mechanical stress and subsequent vocal fold trauma.[11] Visualization is considered to be the main method of diagnosis as perceptual evaluation, which includes acoustic and aerodynamic measures, alone is insufficient.[12] Laryngeal videostroboscopy, an imaging technique, is commonly used to view the vocal folds: this procedure can be performed nasally or orally.[14] Additionally, using amplification devices, such as speakers or microphones, is recommended for individuals who speak to large, and even small groups or in the presence of background noise.[15] Consumption of caffeine in large quantities is dehydrating and is therefore implicated in an increased risk of vocal fold nodules.[14] Behaviours such as frequent throat clearing, shouting, speaking over background noise, and hard crying are associated with an increased risk of developing nodules and other vocal pathologies.[14] Furthermore, unconventional voice practices such as speaking in the falsetto register, cause excessive strain and may result in nodules.However, those who sing professionally or otherwise should take serious consideration before having surgery as it can affect the ability to sustain phonation, as well as alter the vocal range.[20] While the patient is subdued under general anesthesia, long thin scissors and scalpels or CO2 surgical lasers might be used to remove the nodules.