Dear Dr. Jahn,
I’m confused. I have developed a hoarse voice, and saw a couple of ENT doctors. One said I had a nodule, the other one thought I had a polyp. Are they not the same thing?
Confused
Dear Confused,
In fact, polyps and nodules of the vocal folds are quite different entities, both in how they develop, and how they should be treated. Vocal fold nodules are like calluses that form when the vocal folds are habitually rubbed together with excessive force. They are classically seen on both vocal folds, and form at the point of maximal trauma, one third of the way back from the front of the larynx. They are symmetrical, and may be small or large, soft or firm. The treatment for nodules is to change how you use your voice: less force, less “muscling”, more support and a mixed belt.
Simple removal, whether with instruments or a laser, usually doesn’t solve the problem, since continued vocal abuse will simply cause them to recur. So, therapy is the answer. Rarely, surgery will help to make therapy more effective, but do not run to have them removed without working on your technique.
Polyps, by contrast, are usually only on one vocal fold; these develop after a hemorrhage. While most hemorrhages will resolve completely with strict voice rest, if you are not aware that you have had some bleeding into the vocal fold and continue to sing, you may well form a polyp. Polyps are not a sign of poor technique. They simply form when there has been an episode (usually a single episode) of vocal trauma resulting in bleeding. They do not indicate chronic vocal abuse. So, unlike for nodules, the treatment for polyps involves medication (cortisone), and then possibly surgical removal.
I would advise someone like you to get a third (deciding) opinion. As you see, polyps and nodules are quite different, and require different management for a good result.
-Anthony F. Jahn, MD, FACS, FRCS(C)
This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.
Dr. Jahn is an internationally renowned otolaryngologist based in Manhattan with a sub-specialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Mount Sinai School of Medicine and Westminster Choir College in Princeton. He is Medical Director at Jazz at Lincoln Center, and former Director of Medical Services at the Metropolitan Opera in New York. Dr. Jahn has published several books for vocalists, including “Vocal Heath for Singers” (Singdaptive) and “The Singer’s Guide to Complete Health” (Oxford University Press).
