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Nodules of vocal cords
Last reviewed: 23.04.2024
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Professional diseases of the vocal apparatus (chronic laryngitis, nodules of the vocal folds) - diseases of the larynx developing in persons of voice-speech professions when performing professional voice functions or with prolonged (without rest) voice activity, as a result of inept use of background breathing, modulation in height and sound power , incorrect articulation, etc.
Nodules of the vocal folds, also called "singing knots" or hyperplastic nodules, are small paired nodules symmetrically located on the edges of the vocal folds on the border of the lateral and middle third of them, a very small size (pinhead) consisting of fibrous tissue. Sometimes they take a diffuse form and spread to a large surface of the folds, causing significant disturbance of the voice timbre.
Epidemiology
The prevalence of occupational diseases of the pharynx and larynx among persons of the voice-speech professions is high and reaches 34% in some professional groups (teachers, educators). And there is a clear dependence on the length of service, the incidence is higher in the groups examined with experience more than 10 years.
Causes of the nodules of vocal cords
Professional diseases of the vocal apparatus develop in teachers, kindergarten teachers, vocalists, drama artists, announcers, guides, guides, etc. Of particular importance here is work in a foreign language, when mistakes in the technique of speech cause a sharp strain of the cervical musculature, and an insufficiently good respiratory support leads to a significant displacement of the larynx forward, which reduces the tone of the vocal folds.
In addition to the main etiological moment (overstrain of the vocal apparatus) in the development of occupational diseases of the vocal apparatus, the specificity of working conditions is important (neuro-emotional tension, increased intensity of ambient background noise, poor room acoustics, ambient temperature drops, excessive dryness and dustiness of the air, uncomfortable working posture etc.). Promote the development of occupational diseases of the larynx, non-compliance with voice hygiene (smoking, alcohol) and inflammatory diseases of the nasal cavity and pharynx. An important role is played by allergization of the body with the development of hypersensitivity to irritants such as dust, screes of colors from the scenery, make-up, as well as fatigue and psychogenic trauma.
It is also assumed that the etiological factor of the nodules of the vocal folds can serve as submucosal microhematomas, which are formed during an extremely strong voice load, after resorption of which fibrotic proliferation of connective tissue with the formation of nodules. However, this supposition is rejected by Ch.Jackson (1958), who believes that hematomas of vocal folds underlie the formation of polyps.
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Pathogenesis
These nodules are not tumors in the morphological sense of this term, but have the appearance of proliferation of the connective tissue of the vocal fold. Usually, these formations arise when they are strained during shouting, singing, recitation with a loud voice, especially according to a number of foreign phoniatric studies, in cases when sounds of high registers are used for voice formation, so singing knots are found in soprano, coloratura soprano, tenors and countertenors and very rarely contralto, baritones and basses.
In stroboscopic studies, it was found that at the level at which the singing nodules occur, when phonation of high tones the vocal folds take a more convex shape and, therefore, are more closely and for a longer time adjoined to each other. As a result of this, a bilateral, limited focus of inflammation first appears at the indicated site, followed by the hyperplasia of connective tissue fibers, which are most sensitive to mechanical and inflammatory irritations, with continuing voice loads.
From the nodules of the vocal folds, sometimes "polyps" can develop, having the same histological structure as the nodules preceding them, hence - the same pathomorphogenesis.
Symptoms of the nodules of vocal cords
The main complaints of persons using the voice apparatus in their professional activities are fast fatigue of the voice, the sound of the voice in an incomplete range (the voice "sits down"), a feeling of discomfort in the throat, dryness, and perspiration. Among workers with experience in the profession from 3 to 10 years, there are disorders of voice (dysphonia) up to complete hoarseness (aphonia), sore throat and neck when performing voice-speech functions.
The initial period of the disease is characterized by the development of functional disorders in the vocal apparatus, which are most often manifested in the form of fungal growth. Fostastenia (from Greek phone - sound and asteneia - weakness) is the most typical functional disorder that occurs mainly in persons with voice-speech professions with an unstable nervous system. The main cause of its occurrence is an increased vocal load in combination with various adverse situations that cause disorders of the nervous system. Patients with phonosthenia are characterized by complaints of rapid fatigue of the voice; paresthesia in the neck and throat; Persecution, sadness, tickling, burning; feeling of heaviness, tension, pain, spasm in the throat, dryness, or, conversely, increased production of mucus. Very typical for this pathology are the abundance of complaints and careful detailing of their patients. In the initial stage of the disease, the voice sounds normally normal, and endoscopic examination of the larynx does not reveal any abnormalities.
Often the formation of nodules of the vocal folds is preceded by catarrhal laryngitis and a long-term current growth. The latter forces the patient to strain the voice apparatus, and the former promotes proliferative processes, the result of which can be not only nodules, but also other benign tumors of the larynx. In the initial period of knot formation, patients feel slight fatigue of the vocal apparatus and inadequate formation of singing sounds with pianos (quiet sounds), especially in high tones. Then there is a deformation of the voice with any sounds: a feeling of "splitting" of the voice, an admixture of vibratory sounds, while loud speech requires a considerable tension of the voice apparatus. This is due to the fact that during phonation the nodules prevent the full closure of the vocal folds, because of which the resulting slit causes an increased airflow, lowering the backlash air pillar, and the voice power can not reach the desired level. Laryngoscopy reveals changes.
In children, the nodules of vocal folds are observed most often at the age of 6-12 years, more often in boys whose voice apparatus is in the stage of hormonal development more prone to alteration with voice loads. It should be borne in mind that children's games at this age are invariably accompanied by appropriate cries. It is noted that the formation of nodules of vocal folds in children is often accompanied by secondary catarrhal laryngitis, caused by the presence of adenoids and a violation of nasal breathing. Removal of adenoids in such children, as a rule, leads to spontaneous disappearance and nodules of the vocal folds.
Forms
Diagnostics of the nodules of vocal cords
Diagnosis of nodules of the vocal folds does not usually cause difficulties. The main distinguishing feature is the symmetry of the location of the nodules, the absence of other pathological endolaryngeal signs and the history of the disease. Sometimes, in the pathology of the larynx, a young laryngologist can take voice appendages of arytenoid cartilages for singing nodules, which, in case of an individual feature, protrude into the vocal cavity; however, their functional purpose and their absence between the vocal folds, which are completely closed, become obvious in phonation. To make sure of this, it is enough to conduct a stroboscopic examination of the larynx.
The diagnosis of lumbar sprouts requires the obligatory application of modern methods of studying the functional state of the larynx - laryngostroscopy and micro-laryngostroscopy. Characteristic findings with laryngostroboscopy in these patients are unstable and "variegated" stroboscopic pattern, asynchronism of vocal folds, their small amplitude, frequent or moderate tempo. Typical is the lack of "stroboscopic comfort," that is, when conditions are created for absolute synchronization of the frequency of pulsed light and vibrations of the vocal folds, instead of immobile voice folds (as is normal), abrupt or twitching in some of their areas resembling jitter or flicker is seen. With long-lasting severe forms of phaesthesia leading to organic changes in vocal folds, the absence of a phenomenon of displacement of the mucosa in the region of their anterior margin is typical.
Of organic dysphonia, the most common are occupational diseases such as chronic laryngitis and "nodules of singers". Quite rare among the "voice professionals" are contact sores of the vocal folds. The endoscopic picture of the listed diseases is typical. It should be noted that not only the aforementioned diseases of the voice-speech apparatus concern the professional, but also their complications and direct consequences.
Thus, the presentation of the general otorhinolaryngology of chronic laryngitis as a precancerous process gives grounds in a number of cases to consider the laryngeal neoplasm (in the absence of other etiological factors) professional if it developed in the patient - a "professional voice" who had a history of chronic inflammation of the vocal folds.
It should be noted that up to the present time there are no specific objective criteria for occupational affiliation of diseases of the vocal apparatus, which sometimes leads to errors in diagnosis and incorrect decision of expert questions. Therefore, in order to determine the professional nature of the larynx disease, a careful study of the anamnesis (excluding the influence of other etiological factors, in the first place, smoking, alcohol intake, trauma, etc., frequent treatment in the health facility for acute inflammatory zab timetotal larynx or pharynx). Crucial is the study of the sanitary and hygienic characteristics of working conditions in order to determine the degree of voice load. Admissible rate of voice load for voice speech professions is 20 hours per week. In addition, it is necessary to take into account the potentiating effect of the accompanying factors of the surrounding production environment and the labor process. Objective criteria are the data of dynamic observation of the upper respiratory tract, and primarily the larynx, using methods to determine the functional state of the larynx.
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Treatment of the nodules of vocal cords
Treatment of patients with occupational diseases of the vocal apparatus is based on the principles of treatment of non-professional inflammatory diseases of the larynx. In all cases of dysphonia, it is necessary to observe the voice and personal hygiene of the voice (excluding smoking, drinking alcohol), avoid hypothermia. It is necessary to sanitize foci of chronic infection.
Medication
With organic diseases of the larynx, anti-inflammatory therapy, antihistamines, instillation of oils into the larynx are indicated. With vasomotor changes, a good therapeutic effect is the installation of oils to the larynx in combination with a suspension of hydrocortisone, ascorbic acid. At subatrophic processes alkaline inhalations with vitamins, various biostimulants are useful; with hypertrophic forms - with zinc, tannin; with vasomotor - with a suspension of hydrocortisone, procaine. Widely used physiotherapy procedures: electrophoresis on the larynx with potassium iodide, potassium chloride, vitamin E. When fleshing shows the use of additional sedative therapy (tranquilizers: diazepam, chlordiazepoxide, oxazepam, etc.). To increase the vitality of these individuals, it is recommended to use the extract of the noble deer antlers, ginseng extract, and eleutherococcus. Of the physiotherapy procedures for the growth of a good effect have hydroprocedures (wiping with water, coniferous baths), rinsing the pharynx with sage, chamomile. To prevent recurrence of fungal growth, voice overexertion, various situations that negatively affect the nervous system, should be avoided.
Examination of work capacity
Examination of both temporary and persistent disability in occupational diseases of the vocal apparatus requires a special approach. About temporary disability in the persons of voice-speech professions it is in the case when the pathological process that has arisen in the larynx is not long, reversible and after a short period of time the work capacity is fully restored. This can be with the growth of fungi, injuries and hemorrhages in the vocal folds, that is, with the initial forms of occupational disease.
Temporary disability in the voice vocational profession is complete. This means that the employee for some short period is not suitable for professional work, since any violation of the voice regime (silence mode) can aggravate the course of his illness.
Persistent disability in people with voice speech professions is more likely to occur with exacerbations of chronic laryngitis, recurrent frontal growth, monochorditis and other diseases of the larynx. In these cases, the patient needs a long-term inpatient treatment. In the absence of a positive clinical effect from the treatment, depending on the severity of the process and the functional state of the larynx, the patient is referred to the Ministry of Health to determine the degree of disability. Such patients need to be monitored by a phoniatrist and an otorhinolaryngologist and given active treatment.
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Prevention
Prophylaxis of occupational diseases of the larynx should be based, first of all, on the proper professional selection, training of young specialists and students in speech technology, the development of voice hygiene skills. In case of pre-selection it is advisable to conduct a preliminary conversation with a psychoneurologist. Applicants must be sufficiently emotional, able to respond quickly to the situation. Undesirable is the presence of foci of chronic infection in the upper respiratory tract, after the sanitation of which it is necessary to re-resolve the issues of professional suitability.
Absolute contraindication for work in the voice-speech professions are acute and chronic diseases of the larynx: chronic diseases of the pharynx of the dystrophic (especially subatrophic) nature, vasomotor and allergic reactions of the mucous membrane of the upper respiratory tract. Preliminary and periodic medical examinations are a prerequisite for prevention.
It is desirable to carry out the adapted sanitary and educational work with the consideration of the necessary knowledge of speech technology, the use of a voice device, the methods of autogenic training.