I'm a singer and I've had vocal nodules for about six months now and I've seen no improvement with six months of less talking and singing. My whole life has been adversely affected and its incredibly tiresome. How can you tell if the nodules are soft or hard? Do you recommend surgery? Does vocal nodule surgery scar the voice?
Melissa Kim M.S., CCC-SLP replies...
Whether vocal fold nodules are acute ("soft") or chronic ("hard") is a determination typically made after visual examination (laryngeal stroboscopy is the gold standard in this case) in addition to the patient's history.
Voice rest - even for six months - is not typically a recommended treatment for vocal fold nodules... although short-term vocal rest may result in some reduction of the nodules, the functional laryngeal behaviors that contributed to nodular development in the first place will usually result in persistence of the lesions. The primary treatment strategy for vocal fold nodules is voice therapy with a speech pathologist who specializes in the treatment of voice disorders. If your vocal fold nodules do not resolve with vocal conservation and voice therapy, surgical removal is an option. There is always a risk of scarring with any vocal fold surgery, resulting in long-term hoarseness; however, surgery performed by an experienced laryngologist (an Ear, Nose, and Throat physician with specialty training in treatment and surgery for the voice) minimizes this risk.
Good luck to you!