Vocal fold nodule

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Vocal cord nodule
Classification and external resources
Histopathologic image of vocal fold nodule or polyp. Biopsy specimen. H & E stain.
ICD-10	J38.2
ICD-9	478.5
DiseasesDB	29628

A vocal cord nodule is a mass of tissue that grows on the vocal folds (vocal cords). Typically this mass will appear on the junction of the anterior and middle two-thirds of the vocal fold, where contact is most forceful.

A vocal cord nodule reduces or obstructs the ability of the vocal folds to create the rapid changes in air pressure which generate human speech. Symptoms include hoarseness of speech, painful speech production, frequent vocal breaks and reduced vocal range. Females are most likely to develop nodules.

The nodules appear as symmetrical swellings on both sides of the vocal cords. The cause of these formations are usually strenuous or abusive voice practices such as yelling and coughing. Persons who are often susceptible are those who use their voice constantly in a loud environment. Examples include teachers, cheerleaders, politicians, actors, preachers, and singers.

Prognosis

Vocal cord nodules, although they can certainly impair one's speaking and singing ability, rarely harm one's general health. Indeed, the psychological trauma of being diagnosed with nodules—a trauma affecting those especially whose professional success depends on consistently producing a rich and powerful vocal tone (e.g. singers, actors, broadcasters) -- typically dwarfs the limited systemic and even otorhinolaryngological effects.

Treatment

Treatment, or voice rehabilitation, usually involves vocal training, speech therapy, and, occasionally, vocal rest. In rare cases, surgery may be required. Removal of vocal cord nodules is a relatively safe and minor surgery. However, those who sing professionally or otherwise should take serious consideration before having surgery. While the patient is subdued under general anesthesia, long thin scissors and knives are used to remove the nodules, or CO2 surgical lasers might be used which are very effective in such cases. The best preventive steps seem to be wrapped up in the study of vocology, the science and practice of voice habilitation.

Symptoms of vocal nodules include vocal fatigue and hoarseness or breathiness. Hoarseness or breathiness that lasts for more than two weeks may signal a voice disorder and should be followed up with an appointment with ENT.

Famous nodule sufferers

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• Tiffany Hwang, a member from the popular South Korean pop group Girls' Generation developed vocal nodules in late 2008 during promotions for a song. In mid-2009 with promotions for the group's new mini-album, her voice became much huskier and hoarse, causing her to occasionally have to lip-sync during performances. After getting treatment in a special clinic for singers with vocal nodules, her voice recovered almost fully.

• Amanda Palmer of The Dresden Dolls said in January 2008 that she will undergo surgery for nodes in March 2008. She was forced to cancel a mini-tour because of the surgery.

• Angela Gossow of Arch Enemy had developed nodules after the first Arch Enemy album she screamed called Wages of Sin. She can still scream, but can no longer do many growls and deep toned screams. Her voice is much clearer and understandable after going to vocal lessons.

• Davey Havok, lead singer of AFI, suffered from vocal nodes, which forced AFI to cancel several shows on their Spring '04 tour as well as changed the style of his singing from a raspier style to a clearer style.

• Roughton Reynolds from Enter Shikari developed nodules and as a result missed several shows on their UK tour.

• Luciano Pavarotti developed vocal cord nodules early in his at-the-time mediocre career, leading him to renounce a life of music. The psychological release associated with this decision and soon-after disappearance of the nodules lead to an improvement in his sound quality.

• Freddie Mercury pianist and lead singer of Queen. He refused surgery.

• Natalie Imbruglia developed nodules during the 90's and had them removed a few years later, this noticeably improved the timbre in her voice.

• A young Lucinda Williams developed nodules and later had them removed.

• Julie Andrews suffered from vocal cord nodules and lost her singing voice after surgery to remove them.

• Robert Plant, singer of band Led Zeppelin received treatment for nodules in 1973 and possibly 1974. This resulted in a drop in range of voice and a harsh timbre on the 1975 album Physical Graffiti.

• Bonnie Tyler, in 1977, had to have surgery for their removal. After the surgery was performed, she was ordered to not speak for six weeks. One day while healing, she accidentally screamed and her voice took on a raspy quality.

• Whitney Houston developed nodules during her Bodyguard tour in 1993-1994. At the time, she was unable to rest her voice to prevent permanent damage. She returned to a singing career, but her voice has developed a noticeable, darker and hoarser tone than before.

• Sarah Brightman developed nodules after her Harem world tour in 2004; she had surgery to remove them.

• Bette Midler developed nodules in 2006-2007.

• Natalie Dessay, a famous operatic lyric-coloratura, underwent surgery in 2001 to remove nodules and polyps on two of her vocal cords, following vocal difficulties after recovering from a cold. Although the quality of her voice now is debatable by some opera critics and fans, Natalie Dessay has made a complete recovery and continues to perform in opera.

• Justin Timberlake had surgery to remove vocal nodules in 2005.

• Omarion, formerly of boy-band B2K also had surgery to remove nodules in 2005, and as a result, had to cancel a number of live shows in London.

• In March 2005, Blue singer Lee Ryan developed a nodule, and as a consequence had to cancel the boy band's farewell tour.

• Geri Halliwell of the Spice Girls had nodules removed^[1] before the release of her third solo album and later received singing lessons to adjust to her new found vocal range.

• Goo Goo Dolls' lead singer Johnny Rzeznik, Everclear lead singer Art Alexakis, and Tony Rice, bluegrass guitarist and singer, all have suffered from the condition.

• Steve Augeri of the band Journey was forced to leave the band when his nodules became severe in the 2006 tour.

• In October 2006 Jet guitarist and singer Nic Cester was diagnosed.

• Bert McCracken, vocalist of The Used, developed a nodule in his vocal cord, and underwent surgery during the summer of 2007. The nodule was successfully removed.

• Sonny Moore, vocalist of From First to Last, also had a nodule in his vocal cord. After surgery for its removal, he tore a vocal cord.

• Joss Stone had nodules and was told by doctors that she had to rest her voice otherwise permanent damage could be caused.

• Tom Keifer, lead singer of the rock band Cinderella, developed nodules as a result of his singing voice, a raspy, affected snarl. He underwent repeated surgeries for the disorder.

• Billy Lunn (Morgan) lead singer of The Subways had nodules removed in January 2007.

• Korean Singer Gummy has reported that she occasionally suffers from vocal fold nodules.

• Brian Joo of Korean boyband Fly to the Sky suffered from vocal fold nodule due to a hectic promotion schedule and an over-exertion of his vocal cords.

• Daesung of Korean Hip-Hop group, Big Bang (group), developed vocal fold nodules during training.

• Canadian rock artist Matthew Good was diagnosed with a nodule in the late days of the Matthew Good Band.

• Singer Lisa Origliasso of the Australian duo The Veronicas suffered from nodules in her throat while touring with Ashlee Simpson in June 2006. She had to cancel the rest of her tour gigs while she went for an operation and recuperated.

• Emily Deschanel was forced to give up singing after performing in a musical due to the formation of nodules on her vocal cords.

• Mariah Carey, credited with a 5-octave vocal range and known for her extensive use of the whistle register (the highest human vocal register) divulged in a recent magazine interview that she has had vocal nodules since she was a little girl.

• Bill Kaulitz, lead singer of Tokio Hotel, underwent surgery to remove a developed cyst in April 2008. Bill had to remain silent for ten days after his surgery, a feat for the chatty singer. As a result, the band had to cancel numerous shows of their European 1000 Hotels '08 tour.

• Kim Kyung Ho, a Korean rock singer was diagnosed with vocal nodules in 2001, whilst recording his 6th album. As a result his trademark use of screams and vocal wails have diminished, as well as his vocal tone when attempting higher notes.

• Shayne Ward sang through nodules on The X Factor tour before having them removed by a Surgeon in Los Angeles.

• Former Village People lead singer Victor Willis had surgery at a San Diego hospital in July 2008 to remove nodules from his vocal cords. He developed hoarseness after several 2007 performances, forcing him to cancel European and Canadian concert dates.

• In January 1987, Elton John underwent throat surgery to remove potentially cancerous nodules from his vocal cords while on tour, a necessity he originally claimed was due to an infection, but later claimed was the result of excessive drug abuse.

• Syleena Johnson suffered from vocal nodules and had to go through speech therapy.
• Minne Riperton also suffered from vocal nodules

• Madonna came down with vocal nodules and had to stop her tour.

• In April 2008, ex Blue Peter and Radio/TV presenter Richard Bacon had an operation to remove a noncancerous polyp from his vocal cords.

• Joni Mitchell suffered with vocal nodules in the 90s.

• Broadway legend Patti LuPone suffered with vocal nodules in 1994, and had surgery to remove them.

• In January 2008 Miss Saigon star Lea Salonga was instructed to go on complete vocal rest for a while due to pre-nodules and inflammation of her vocal cords.

• Kerry Butler, star of Hairspray (musical) and Beauty and the Beast (musical) developed pre-vocal nodules and had to go on complete vocal rest for over a month.

• Miley Cyrus, star of Hannah Montana developed vocal nodules.

• Klaus Meine of Scorpions suffered from vocal nodules.

• M. Shadows of Avenged Sevenfold had to postpone a fall tour due to vocal strain.

• Ian Gillan of "Deep Purple" and "Jesus Christ, Superstar", suffered from vocal nodules in the early 1980s.

• Nathan Lane developed a vocal nodule/polyp on his left vocal cord that forced him to take time out of his run in the Broadway production of The Producers (musical).

• Eliza Carthy cancelled a tour of England in Autumn 2008 because of vocal fold nodules.

• Rod Stewart had a nodule removed in June 2000.

• Tony Vincent, of We Will Rock You (musical) fame, suffered with vocal problems during his time in London and underwent surgery.

• Kerry Ellis, acclaimed West End performer, suffered vocal damage upon opening her run as Elphaba in Wicked (musical) and later developed nodules as a result of simultaneously recording tracks for her album, rehearsing for Chess (musical) and performing in Wicked.

See also

• Human Voice
• Vocology
• Otorhinolaryngology#Laryngology

References

External links

• Vocal disorder support group (VoiceMatters.net)
• photo of nodules
• Voice therapy for adults: vocal nodules, voice strain, Caroline Bowen, PhD
• Voice therapy for children (1), Caroline Bowen, PhD
• Voice therapy for children (2), Caroline Bowen, PhD