When is surgery for vocal cord nodules indicated?
Indications for voice surgery of vocal fold nodules:
- Hoarseness
- Rough, breathy voice
- Rapid vocal fatigue
- Loss of singing voice
Vocal fold nodules usually present as bilateral tissue thickened masses in the mid-third of the vocal folds. In the early stages, vocal cord nodules are usually responsive to voice therapy or anti-inflammatory medication; the larger and hardened vocal cord nodules mostly have to be managed phonosurgically.
The indication for a phonosurgical intervention is rendered based on the subjective clinical picture. The cardinal symptoms are usually a more or less pronounced hoarseness, limitations in voice projection accompanied by fast vocal fatigue.
The degree of hoarseness mostly corresponds to the size of the nodules. Primarily, women in adolescence or middle age develop vocal fold nodules.
Vocal cord nodules before surgery
Vocal cord nodules after surgery
How is surgery performed on vocal cord nodules?
Since vocal fold nodules are a condition affecting the superficial layers of the tissue, it is not necessary to cut open the vocal folds as in other diseases. Usually, it is sufficient to carefully remove the vocal fold nodules and microsurgically reconstruct the vocal fold margin.
The surgical technique favored by Dr. Wohlt involves plastic reconstructive surgery of the vocal fold margin: the diseased vocal cords are surgically managed to return each vocal fold’s capability of symmetrical, equilateral vibration.
The first step necessary is to microsurgically remove the fibrotic mass – exactly at the line of demarcation; in other words, in the zone where the diseased tissue transitions to the healthy.
Afterwards, meticulous reconstruction is applied to smooth the vocal fold margin into shape. In doing so, care must be taken to create the smallest possible wound to the mucous membrane on the one hand, while leaving no remnants of the vocal fold nodule, on the other.
Vocal cord nodules before surgery
Vocal cord nodules after surgery
What happens during the postoperative phase after voice surgery of vocal cord nodules?
After surgery of vocal fold nodules, the patient should maintain vocal rest for a period of 10-14 days. The wound is allowed to heal while reepithelialization takes place. This refers to the time interval during which a fine membrane grows over the wound.
Vocal rest during this period is imperative! Whispering is not permitted. Moreover, during the wound healing phase, complete abstinence from smoking is mandated. Given the associated bleeding risk, drinking alcohol should definitely be refrained from during this wound healing phase.
After a period of vocal rest, intensified voice therapy with a specialized therapist is urgently recommended.
Because vocal fold nodules have primarily developed as the result of voice misuse, special emphasis must be placed on correcting the vocal pressure patterns that have become habituated in the patient — indeed, sometimes over years. If these hyperfunctional voice pressure patterns are not corrected postoperatively by a lengthier regimen of voice therapy, a recurrence of vocal cord nodules is to be expected.
The duration of voice therapy should be dictated by the speed and completeness of the patient's response to the exercises.
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