Vocal nodules and Vocal polyp

Both conditions share a common site: The junction of the Anterior 1/3 and Posterior 2/3 of the vocal cord (area of maximum vibration).

1. Vocal Nodules

AKA: Singer’s Nodes / Screamer’s Nodes.

Definition: Benign, symmetrical lesions resulting from chronic vocal trauma.

Features

• Demographics: Teachers, Actors, Pop singers, Assertive children.
• Laterality: Bilateral & Symmetrical.
• Appearance: Pin-head to half-pea size.
  • Early: Soft, reddish, oedematous.
  • Late: Greyish/white (fibrotic).
• Symptoms: Hoarseness, Vocal fatigue, Neck pain.

Pathogenesis (Chronic Process)

Management

• Early Stage: Conservative.
  • Voice rest & Education.
  • Speech Therapy (Essential).
• Late Stage / Adults: Surgery.
  • Microlaryngoscopic excision (Cold steel or Laser).
  • *Care taken to avoid vocal ligament.

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2. Vocal Polyp

Definition: A soft, smooth, often pedunculated mass arising from the vocal cord.

Features

• Demographics: Men (30-50 years).
• Risk Factors: Sudden shouting, Smoking, Allergy.
• Laterality: Unilateral.
• Appearance: Pedunculated; may flop up and down glottis.
• Symptoms:
  • Hoarseness.
  • Diplophonia (Double voice due to different vibratory frequencies).
  • Dyspnoea/Stridor (if polyp is large).

Pathogenesis (Acute Event)

Management

• Primary Tx: Surgical Excision (Microlaryngoscopy).
• Follow-up: Speech therapy to prevent recurrence.

Comparison Summary

Feature	Vocal Nodules	Vocal Polyp
Etiology	Chronic Abuse (Unnatural low tones/High intensity).	Sudden Shouting (plus Allergy/Smoking).
Pathology	Fibrosis, Hyalinization & Epithelial Hyperplasia.	Haemorrhage & Oedema.
Laterality	Bilateral (Symmetrical).	Unilateral.
Key Symptom	Vocal Fatigue / Pain.	Diplophonia / Stridor.
Treatment	Conservative first (Speech Tx).	Surgery first (Excision).