Nodules on the vocal cords of a child treated with folk remedies. Why do nodules appear on the vocal cords: causes, symptoms, diagnosis and treatment Nodules on the vocal cords in children

If the child's voice becomes hoarse, the first thing parents think is that he has caught a cold again. But, apart from a “shallow” voice, there are no symptoms that accompany colds and infectious diseases, for example, vocal fold nodules.

Why do nodules appear?

Diseases that affect the vocal cords are accompanied by an altered voice timbre. With laryngitis, laryngeal diphtheria or papillomatosis, the ligaments undergo changes, increase in size, swell and do not fit tightly. As a result, the voice changes. If therapy is carried out, the vocal cords return to normal and gradually regain function and elasticity.

Frequent inflammatory processes in the respiratory organs serve as a prerequisite for the formation of nodes on the free edge of the ligament.

Inflammation changes the trophism of the ligament tissue in the larynx, and the movement of lymph and blood is disrupted. The tissue grows, the tubercles gradually protrude and, if the load does not subside, they increase in size.

In a child who has not suffered any colds, bumps on the tissue appear after screaming or loud conversation:

1. The speech organs, in particular the vocal cords, experience prolonged stress and excessive blood flow.
2. Areas of tissue compaction gradually form.
3. Over time, if the load continues at the same pace, they harden.
4. If they formed a long time ago, the process is chronic.

When function decreases thyroid gland and gastroesophageal reflux disease there is a possibility of formation of nodules on vocal cords.

Are growths on the vocal cords dangerous?

Normally, a child's voice is clear. If he “sits down” for no apparent reason, this is a reason to visit an otolaryngologist. An examination will reveal what caused the change in voice timbre. “Screamer's nodules” are the name given to lumps on the vocal cords. The tubercles prevent the edges from meeting tightly to produce a clear sound. Treatment helps improve the situation.

Laryngeal papillomatosis cannot be excluded. The outgrowths resemble cauliflower inflorescences. The condition is diagnosed frequently; nodules cover the larynx and surrounding tissues. The growth of papillomas changes the timbre of the voice and makes breathing difficult.

Symptoms and diagnosis

During laryngoscopy, mucus is found on the ligaments; it is located on the border between the middle and anterior parts. When coughing up sputum, symmetrical irregularities along the edge are found in this part of the vocal cords.

At the beginning of the pathology, the protrusion is noticeable only on one ligament. Constant trauma leads to the appearance of a symmetrical unevenness on the second ligament. With severe symptoms, the nodules grow to the size of a pinhead, which interfere with tight closure. Air passes freely into the gap formed and reduces vibration, causing the voice to acquire a rattling, hoarse sound.

Just as every disease has symptoms, vocal fold nodules are determined by the following signs:

• The first sign of nodules is a hoarse voice. After a short rest, the timbre is slowly restored. There is no sore throat when talking. The constant “work” of the ligaments and tension increases blood flow and swelling.
• Seals on the edges of the ligaments are located symmetrically, in pairs - obvious symptoms that indicate nodules of the vocal cords. These are distinctive features from polyps, cysts and tumors.
• At first, the nodes are invisible and blend in color with the mucous membrane of the throat. A little later, the calluses lighten and become white.

It is hardly possible to examine the larynx at home, especially in a child. It is necessary to visit an otolaryngologist:

1. The doctor asks parents about the child’s habits, behavior, daily routine, and hobbies.
2. He will be interested in hereditary diseases and past infections.
3. To make a diagnosis, an ENT doctor will examine the nasal and nasopharyngeal cavities, pharynx and larynx.

Laryngosopia in children is performed under anesthesia. In adults, the larynx is examined with a rigid endoscope, the manipulation is unpleasant, and it is difficult for patients to cope with the gag reflex.

Treatment methods. What and how should you do?

The basis for treatment will be the results of laryngoscopy. Silence mode helps to improve the condition and return to a “normal” voice. While the child does not need to talk, there is no rush of blood, there is no friction, the nodules of the vocal folds are at rest.

1. For a certain period, the patient must remain silent or maintain a limited mode of communication.
2. Doctors do not recommend talking in a whisper. The fact is that the ligaments become more tense. It is much more useful to speak out loud, but quietly and try not to make an effort.
3. It is difficult for children to forbid talking and observe the “silence regime”. The task of adults is to help the child, to prevent loud screaming or talking. Perhaps games that will captivate the child so much that he will be busy most of the time will help.
4. Older children are prohibited from talking, reading aloud, or screaming. Participation in choirs and sports competitions is temporarily suspended. Efforts are directed towards preventing conversations.
5. The “silence mode” for small patients may take a period of at least 2 weeks.
6. Parents pay special attention to their child’s diet. The dishes are prepared light and nutritious. They should not be “dry” and be sure to monitor the temperature of the food. Hot ones are dangerous due to burns, cold ones increase the risk of inflammation, which should not be allowed.
7. The air in the room is humidified forcibly.
8. The doctor prescribes oil infusions into the larynx if they make sense for treatment.
9. With age-related “breaking” of the voice, the nodules of the vocal folds may disappear if a gentle regimen is followed.

It is difficult to say with certainty that these methods will be effective. IN initial stage disease there is a chance to return the previous condition of the vocal cords.

Treatment options. Additional treatment measures

“Silence mode” does not always bring results:

1. Local vocal cord nodules treated with lapis solution. Protargol 2% or lactic acid 2% is used for treatment to cauterize calluses.
2. It is possible to reduce the size of the tubercles using anti-inflammatory drugs. Steroid hormones are prescribed to reduce swelling. Even with such therapy, it is unlikely that you will be able to get rid of the nodules, but a slight improvement is possible.
3. According to indications, nodules on the vocal cords removed by surgery. Prescribed in extreme cases, only for large calluses. The operation is performed with endoscopic instruments. After the procedure, relapse is possible.

1. Laser removal Cryosurgery also shows effectiveness. It is possible to recover after the operation in two weeks, if the patient does not neglect the doctor’s recommendations. Be sure to observe peace and silence. Smoking is prohibited.

No matter how events develop, it is necessary to treat changes in the throat. This will keep you feeling well, maintain your health and voice.

Vocal fold nodules are small benign formations that arise symmetrically on both vocal folds at the border of the anterior and middle thirds of their length - the point of their tightest closure during phonation (Fig. 11).

Nodules in adults are usually called "singer's nodules" and in children - "screamer's nodules." According to the literature, among adults they most often occur in women aged 25-30 years, among children - in boys 8-12 years old. The size of the nodules ranges from poppy seed to millet grain.

The main reason for their formation is to force the voice. In singers, nodules (where the name “singing” comes from) appear when they force their voice, sing beyond their vocal capabilities, or have insufficient command of vocal technique. Often teachers and lecturers develop nodules. The reason is the same: forcing the voice in the absence of correct voice skills.

Children who have nodules on the vocal folds are usually very mobile, noisy, and loud. According to A. Mitrinovic-Modrzewska (1965), the background for their appearance is a decrease in the tone of the vocal folds, as well as colds and infectious diseases of the upper respiratory tract.

The presence of nodules changes the voice. Hoarseness of varying degrees of severity, trembling and trembling of the voice, inability to correctly intonate sounds, aspiration when speaking and singing appear; complaints of great tension and vocal fatigue.

Singing nodules form gradually. At first, these are small soft formations that respond quite well to drug treatment. A necessary condition for the effectiveness of treatment is a temporary limitation of vocal load and a change in the manner of vocal delivery. If treatment of already formed nodules is delayed, drug and physiotherapeutic treatment is not successful and surgical intervention is indicated. Children with vocal fold nodules do not undergo surgical treatment until puberty.

In any case - during treatment or after surgical removal - it is necessary to carry out phonopedia, the tasks of which include changing the method of voice production and strengthening the vocal and respiratory muscles.

At the preparatory stage, after explaining the need for special functional training of the vocal apparatus, breathing correction begins. Target breathing exercises- formation of the bone-abdominal type of breathing and finding respiratory support. During the first lessons, breathing is trained in a lying position with control over the movement of the abdominal wall and lengthening the exhalation through the mouth, as described in previous sections.

Then breathing exercises using the complexes presented in the Appendix (on pp. 137, 138 - for adults and on pp. 133, 134 - for children) are carried out either in the physical therapy room or by the speech therapist himself.

With children younger age It is better to carry out training in a playful way. For example, such games are used.

1. "Trumpeter". Starting position: sitting on a chair, hands clenched into a tube near the mouth and raised up. Inhale, then exhale slowly through the tube while saying pf-f.

2. "Semaphore". Starting position sitting on a chair, while inhaling, raise your arms to the sides, while exhaling, slowly lower them, saying a long s-s.

3. "Pendulum". Starting position: standing, feet shoulder-width apart, hands on the belt. Inhale, then, as you exhale, tilt your torso to one side, then to the other, saying wow.

4. “Chopping wood.” Starting position: standing, feet shoulder-width apart. Raise your hands clenched above your head - inhale, bend forward, saying as you exhale wow.

5. "The geese are flying." Slow walking. As you inhale, spread your arms to the sides, as you exhale, lower them, saying Mr.

6. "Whistle". Starting position sitting on a chair. In one hand there is a mug of water, in the other there is a straw. Inhale and as you exhale say through the straw into the water u.

Each exercise is performed 4-5 times in a row.

1. Lower your head, touching your chest with your chin, and slowly move it alternately to the right and then to the left shoulder, pronouncing vowel sounds with an aspirated attack.

2. Take a short breath, and as you exhale, with your mouth wide open, place your tongue spread out and relaxed on your lower lip, pushing it out of the mouth as far as possible.

3. Lightly stroke the front surface of the neck and upper chest area with your palms from top to bottom, then gently patting chest, draw out mmm-mmm; n-n-n-n-n.

4. Pronounce syllables on the aspirate attack ha-ha-ha, ho-ho-ho, he-he-he, he-he-he.

These exercises are suitable for both children and adults; each is also performed 4-5 times in a row.

After the described training, a trial method is used to select the optimal sounding and accessible way of delivering the voice on a soft attack. Usually this is the pronunciation of sonorant [m] or [n]. The sound is pronounced “in a mask” in isolation, then introduced into syllables and words. Normal phonation gradually becomes established. The correctness of voice delivery is audited, with a mandatory feeling of comfort and ease of pronunciation.

If the nodules have not yet reached the last stage of their formation (when they become large, fused with the underlying tissues), then phonopedia can lead to their disappearance. In the future, both children and adults who have developed nodules need periodic monitoring both from the point of view of their possible relapse and to monitor the manner and method of vocalization.

Here is an extract from the medical history.

S.V., 8 years old, studies in the second grade. They first went to the doctor on October 18, 1999 with complaints of a sharply hoarse voice. According to the mother, the disorder appeared about a year ago. The family associated this with a cold. Gradually this condition intensified. The otorhinolaryngologist at the place of residence diagnosed me with vocal fold nodules. The boy was sent for additional consultation to the phoniatric department.

On examination, the mucous membrane of the larynx is pink, the vocal folds are pale, and on the border of the anterior and middle thirds there are cone-shaped formations of less millet grain. The vibrations of the vocal folds are synchronous with low amplitude, closure is incomplete, and the duration of phonation is shortened. The diagnosis was confirmed.

According to the mother, the boy is usually restless, noisy, talkative, and screams a lot during games, especially on the street. The medical history is not burdened, but the child often suffers from colds.

Physiotherapy and laryngeal infusions were prescribed, along with phonopedia. After conservative treatment, training continued for 3 months. Phonopedic sessions were conducted on an outpatient basis once a week. At home he studied independently under the supervision of his mother 4-6 times a day for 20 minutes. During this time, it was possible to completely rebuild the manner of voice production. The child began to speak calmly and stopped screaming.

Upon examination at the end of speech therapy, the mucous membrane of the larynx and vocal folds had a normal color, the nodules disappeared, the closure of the vocal folds was tight, their oscillatory movements were synchronous with the usual amplitude. Six months later, during a follow-up examination, no pathology was detected, there were no complaints, the voice had a normal timbre, was ringing, without hoarseness.

Test questions and assignments

1. What causes vocal fold nodules?

2. What contributes to the disappearance of nodules?

3. Is it necessary to correct breathing in children and adults with vocal fold nodules?

4. In what cases is surgical removal of nodules performed?

6. Name the exercises used to relieve tension in the vocal apparatus.

7. Make a lesson plan with a 7-8 year old child who has vocal fold nodules.

People whose profession involves constant “use” of the vocal apparatus most often suffer from the appearance of nodules on the vocal folds. Inflammatory processes in the oropharynx, laryngitis and singing nodules are observed as a result of prolonged singing, loud talking, incorrect voice production, articulation, as well as inept manipulation of sound pitch.

Singers' nodules are paired formations in the form of small nodular growths, localized at the edges of the vocal folds. They are composed of fibrous tissue.

With the development of a diffuse form, the nodules cover the entire surface of the folds, due to which the vocal timbre changes significantly.

Singing nodules are not tumors, but rather “calluses” from heavy load on the vocal cords.

Overgrowth connective tissue appear when the ligaments are overstrained when shouting, talking loudly or singing. Often, nodules are observed in people who use high-pitched sounds for singing, so the pathology is extremely rare in baritones and basses.

Against the background of pronunciation of a high-pitched sound, the vocal folds become more convex. Due to their prolonged contact, a limited focus of inflammation is formed, which is the basis for fiber hyperplasia. This is how nodular growths are formed.

In some cases, singing nodules become polyps without changing the morphological structure. In boys, the pathology occurs at the age of 7-13 years, when, under the influence of hormonal fluctuations, the risk of damage to the vocal folds increases due to heavy loads on the voice-forming apparatus (during playing, screaming).

It has been noticed that nodular lesions are often combined with a catarrhal form of laryngitis, which can be caused by impaired nasal breathing due to adenoids, chronic sinusitis or a deviated nasal septum. In this case, restoring breathing through the nose allows the child to get rid of the nodules.

Damage to the folds leads to hoarseness, loss of vocal sonority and disability. Among the predisposing factors that increase the risk of the disease, it is worth highlighting:

• smoking;
• addiction to alcoholic beverages;
• damage to the voice-forming apparatus in inflammatory diseases of the respiratory system;
• incorrect voice production.

There are several stages that the nodular growth goes through:

• after damage to the epithelium, intensive secretion production begins, which is visualized during laryngoscopic examination;
• the appearance of a small elevation above the surface of the fold due to long-term persistence of the inflammatory process;
• formation of nodular formation.

Clinical symptoms

The disease is characterized by several symptoms:

• rapid voice fatigue;
• hoarseness;
• discomfort, dryness and soreness.

If the experience of intensive “use” of the voice reaches 10 years, a person may notice voice disorders (changes in timbre) or complete absence sonority (hoarseness). You may also experience pain in the neck when talking or shouting.

The initial period of the disease is characterized by phonasthenia ( functional disorder, which is observed in persons with an unstable nervous system). The reason for its development is improper voice control against the background of severe stress. The patient may complain about:

• soreness, tickling, burning in the oropharynx area;
• paresthesia in the cervical area;
• heaviness, pain, spasms in the larynx.

Singing nodules in most cases appear against the background of prolonged inflammation of the larynx. Laryngitis leads to the development of proliferative processes, which can result in various benign neoplasms.

As the pathology progresses, a person loses the ability to form the necessary sound, the voice becomes “split”, and vibration sounds appear.

To speak loudly, a person needs to make a lot of effort. The pathology is caused by incomplete closure of the vocal folds, as a result of which an additional air flow is created and the sonority of the voice changes.

Diagnostics

To make a correct diagnosis, it is necessary to conduct a comprehensive examination. Laryngitis can be detected using laryngoscopy, which will visualize loose, swollen, hyperemic mucosa, covered with mucus.

The main feature of nodules is their symmetrical arrangement. To assess the functional state of the folds, laryngostroboscopy and microlaryngostroboscopy are performed. During the examination, it is possible to detect their asynchronous oscillation and reduced range of motion.

When resting the folds, instead of immobility, you can see chaotic contractions and twitching, reminiscent of trembling.

Currently, singers' nodules do not have objective criteria for determining professional suitability, which sometimes leads to incorrect diagnosis and erroneous examination conclusions. To make a diagnosis of an occupational disease, many factors are taken into account:

• studying the sanitary and hygienic features of the profession (the norm for voice workload is 20 hours per week);
• anamnestic information (smoking, alcohol, injuries, operations on ENT organs);
• frequency of visits to an otolaryngologist regarding inflammation of the larynx;
• monitoring the condition of the voice-forming apparatus;
• features of the labor process.

Treatment areas

When singers' nodules are diagnosed, it is imperative to adhere to the voice mode, avoid hypothermia, smoking and alcoholic drinks. Laryngitis is treated by prescribing anti-inflammatory therapy, antihistamines and instillations oil solutions into the larynx.

Hormonal agents, alkaline inhalations with vitamin components, biostimulants, zinc, and tannin may also be prescribed. The choice of treatment tactics depends on the form of the disease.

Physiotherapy procedures (electrophoresis with iodide, as well as potassium chloride, tocopherol) are widely used. With concomitant dysfunction nervous system the use of sedative medications is indicated. A decoction of chamomile or sage is used to gargle.

The patient is taught to perform special exercises, thanks to which the folds are restructured, which prevents their further damage.

Newly formed nodules can easily be reversed.

Fibrosis develops in “old” nodular formations, so microsurgical removal is recommended. Endolaryngeal removal is carried out using microinstruments and a microscope. The duration of the surgical intervention is about a quarter of an hour. Thanks to local anesthesia, a person does not feel pain or discomfort. Very rarely, general anesthesia is required.

In the postoperative period, a special voice regimen is observed for 20 days. In the first week, anti-inflammatory therapy is carried out.

Return to work is allowed one month after the operation. Do not forget about possible relapses if preventive measures are not followed.

Prevention

Chronic laryngitis is a contraindication for vocal training and the choice of voice-speech professions. To prevent damage to the vocal folds by nodular growths, you must follow some recommendations:

• regular examination by an ENT doctor for early detection of the disease;
• training young specialists in the correct voice “maneuvers”;
• respect for the voice-forming apparatus (you should not shout or sing loudly).

When choosing the profession of a teacher, announcer, toastmaster or vocalist, you need to understand what diseases can develop as a result of prolonged loud talking or singing. By following the recommendations, you can protect your vocal cords from damage and yourself from unpleasant symptoms.

is a pathology accompanied by the formation of connective tissue tubercles on the vocal cords of the larynx. Clinically characterized increased fatigue, decreased strength and hoarseness of the voice, a burning sensation in the throat, a rare dry or unproductive cough. Diagnosis is based on a comparison of the patient’s complaints, characteristics of his profession, test results laboratory research, indirect laryngoscopy and endolaryngostroboscopy, less often - MRI of neck tissue. Treatment includes drug therapy and physical therapy, if necessary, surgical removal of formations is carried out.

ICD-10

J38.2

General information

Nodules of the vocal folds (nodular laryngitis, “singing nodules”) are a relatively common pathology belonging to the group of occupational diseases. According to statistics, the prevalence among people who use the voice as their main work tool ranges from 12 to 35%. In the general population, the incidence is no more than 3-5%. More often pathological condition is detected in people of working age - from 25 to 50 years, with work experience of more than 5-10 years. It practically never occurs in children and adolescents. In females, the disease is diagnosed 1.2-1.7 times more often than in males.

Reasons

The main cause of the disease is acute or chronic overload of the vocal apparatus. The formation of nodules is often caused by regular, prolonged (over several years) overstrain of the vocal folds. Similar changes are observed in people who use the so-called “hard attack” or forced manner of phonation when phonating. “Singing nodules” are considered a typical disease of representatives of vocal professions: singers, actors, teachers and teachers, lecturers, guides, tour guides, builders, and the military. In the etiology of vocal fold nodules, contributing factors are also identified, which include:

• Chronic psycho-emotional stress. Frequent stress and emotional overload lead to disruption of the autonomic nervous system, which subsequently causes tension in the regional muscles and dystonia of the vocal folds.
• Bad habits. Poor vocal hygiene in the form of frequent use tobacco products and alcohol aggravate the negative effects of vocal strain and accelerate the process of nodule formation.
• Pathologies of the nasopharynx. Chronic sinusitis, frontal sinusitis, rhinitis and other pathologies accompanied by postnasal drip syndrome support a sluggish inflammatory process in the mucous membranes of the vocal folds, making them more susceptible to overload.
• Unfavorable environmental conditions. Long stay or work in conditions of increased dryness, dusty inhaled air, high temperatures, their sudden changes reduce the tone of the vocal folds, potentiating the negative effects from the increased work of the voice-forming apparatus.

Pathogenesis

Histologically, nodules that form on ligaments are represented by the proliferation of connective tissue. The pathogenesis is based on a violation of the blood supply to regional tissues, caused by two main factors - dysfunction of the autonomic nervous system and excessive load on the structures of the voice-forming apparatus, which can trigger pathological process both together and separately. Initially, the permeability of regional vessels increases microvasculature. As a result, the liquid part of the blood plasma comes out through the walls of arterioles, venules and capillaries, followed by proteins. The latter undergo coagulation and compaction with the formation of homogeneous inclusions located in the stroma of the vocal folds.

The second mechanism for the formation of nodules of this localization is based on local inflammatory process, caused by long-term deformation of the vocal cords. During phonation, they acquire a convex shape, as a result of which they adhere closely to one another for a relatively long time. This, combined with further vocal stress, provokes bilateral limited inflammation and hyperplasia of connective tissue, which is very sensitive to mechanical and inflammatory effects. Gradually, pathological growths undergo organization and form “singing nodules.”

Classification

Based on etiology, morphological changes and differences in functional tests, vocal fold nodules are usually divided into two large groups. The practical significance of this division lies in a more flexible selection of a preliminary treatment program, a well-founded decision on the feasibility surgical intervention. The following types of nodules are distinguished:

• Swelling or “soft”. Caused by a sharp tension of the vocal folds with their concomitant damage - ARVI, acute laryngitis. Morphologically, they represent glassy edema or limited protrusion against the background of loosened mucous membrane in the nodular zone - at the intersection of the anterior and middle 1/3 of the fold.
• Fibrous-hyaline or “hard.” They are formed with constant, prolonged vocal strain and with continued excessive use of the voice against the background of “soft” nodules. They have a round or conical shape, the diameter depends on the age of appearance, varies from a point compaction to 3-5 mm.

Symptoms

An early clinical manifestation of the pathology is phonasthenia, which includes rapid voice fatigue, tickling, tickling and burning. There is a feeling of heaviness, squeezing, and moderate sore throat, which intensifies at the end of the working day. At the onset of the disease, both dry mucous membranes and excess mucus production may occur, causing a rare cough. Most patients experience paresthesia in the neck, described as “crawling” or “tingling.” Despite the large number of complaints and their clear description, changes in phonation, even among people who use their voice professionally, do not occur at this stage of pathology development.

Over time, the above symptoms are accompanied by hoarseness or hoarseness. The deformation of the voice first appears during the phonation of quiet sounds. Singers note a violation of voice formation during piano phonation. Further defects arise when reproducing any sounds. Patients may complain of a feeling of “voice splitting” and the appearance of additional vibrational sounds. Loud speech requires significant strain on the vocal apparatus and often does not reach the previous level. Among professionals, hoarseness does not always occur; their complaints are based mainly on difficulty intonating high notes and tremors, “decreased voice quality.”

Diagnostics

Making a diagnosis is not difficult for an experienced otolaryngologist. The doctor is guided by the patient’s complaints, the results of his survey, physical and instrumental research methods. Laboratory tests for this pathology are uninformative and are used only for the purpose of differential diagnosis. The diagnostic program for suspected vocal fold nodules includes:

• Anamnesis collection. After detailing the complaints, the doctor clarifies the features of the patient’s profession or lifestyle, first of all, the presence of increased load on the voice-forming apparatus and unfavorable external factors. Recent acute ENT diseases and chronic laryngitis are important.
• Examination of the larynx. During laryngoscopy - visual inspection The larynx and vocal folds reveal mild hyperemia of the regional mucous membrane, pathological formations in the “nodular area”, the detailed characteristics of which depend on the histological form.
• Stroboscopy. With “soft” nodules, during stroboscopy, synchronous medium-amplitude vibrations of the vocal cords are noted with preservation of the vertical and horizontal components, a positive symptom of “displacement” of the mucous membrane. When playing “mezzo-voce”, an “hourglass” deformation of the glottis is detected. Similar changes occur at the initial stage of development of “hard” nodules. Subsequently, asynchrony of oscillations, shortening of the vertical component, and “inhibition” of the mucous wave are formed. Hourglass deformation is observed with forte phonation.
• Tomography. MRI of the soft tissues of the neck is indicated if it is impossible to conduct a full differential diagnosis between vocal fold nodules and other pathologies, including accumulation of mucous secretions on the cords, small papillomas, polyps, cysts or malignant neoplasms.

Treatment of vocal fold nodules

Therapeutic tactics largely depend on the etiology, severity of the disease and the requirements for voice characteristics made by the patient himself or his working conditions. Patients who use their voice professionally, even with direct indications for surgical treatment, often refuse surgery. For “singing nodules” the following means and methods can be used:

• Drug therapy. Combinations of pharmaceuticals are selected individually. Depending on the situation, they can be used antihistamines, NSAIDs, vitamin complexes. Instillations of oils and corticosteroid suspensions are carried out.
smoking, use of respirators when working with harmful volatile substances, normalization of voice load during the working day and proper rest at the end of it, modern treatment acute and protracted ENT pathologies, minimizing psycho-emotional stress.