"Singer's Node"

[MedEye]

Dear ENT fellows,

I'm usually in the ophtho forum, but I was wondering if someone here would be kind enough and answer my question.

Where can I find some information on the web about 'singer's nodes'?
My brother was told he has a 4-mm one on his vocal cord.
Is electro-cautery the usual treatment for this size?

Any help would be greatly appreciated.
Thanks

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[dchaos]

Good luck to your brother.

Singer's nodules are benign laryngeal papillomata that usually present in people who use their voice to excess (singers, screaming kids etc.) as hoarseness.

I was in the latter group of patient about 20 years ago and had my singer's nodule laser ablated as a day case. No complications (although I still can't sing!). I'm not sure what the current therapy is, so I'll kick for touch on that one.

 

[resxn]

Good luck to your brother.

Singer's nodules are benign laryngeal papillomata that usually present in people who use their voice to excess (singers, screaming kids etc.) as hoarseness.

I was in the latter group of patient about 20 years ago and had my singer's nodule laser ablated as a day case. No complications (although I still can't sing!). I'm not sure what the current therapy is, so I'll kick for touch on that one.

Wrong, sorry, I can't let this go. Benign laryngeal papillomata are a far, far cry from a singer's nodule. I mean, seriously, seriously different.

I'm going to get on the attending soapbox for a minute and say that the single most important thing any medical professional has is integrity. If you don't know something don't say that you do. If this was an honest mistake, fine, I apologize for my rebuke, but I see far too often when medical students and residents don't know how to say "I don't know" when it is clear that's the case. Having said all that, I think you did make an honest mistake because you did punt on the treatment portion and I commend you for that.

For true vocal fold (TVF) nodules, see this site for a basic explanation: http://www.entnet.org/healthinfo/throat/Vocal-Cord-Lesions.cfm

For more in-depth discussion, check out www.emedicine.com, register, type in vocal nodules in the serach box and there is a great chapter on the issue delineating anything and everything you'd ever want to know.

No, electrocautery is the last thing you do to a nodule. The vast majority will resolve with speech therapy. The very few that don't can be excised with a microflap procedure using cold steel or sometimes CO2 laser, but I generally recommend the former, especially for small nodules, especially in professional voice users.

 

[Pir8DeacDoc]

For any of your hoops fans out there I think this is what Dick Vitale had. He certainly has enough phono-trauma to get a singers nodule.

 

[dchaos]

Wrong, sorry, I can't let this go....

Thanks for the correction - I neither intended to mislead nor am I incapable of saying "I don't know". My honest mistake was to rely on a (flawed) memory rather than to look this up.

I appreciate your explanation, and I'm sure the OP will too.

 

[resxn]

appreciate your honesty. good to know there are those out there like you.

 

[GMDMD]

but I see far too often when medical students and residents don't know how to say "I don't know" when it is clear that's the case.

Not trying to pile onto the original responder so much as I am agreeing with resxn's general point. I used to be an engineer (still a lowly MSII) and probably the most annoying thing I've found about this field is the relative abundance of fake know-it-alls. I don't mind the real know-it-alls (humbling) and even the know-nothings who are honest.

What's tough is that there are so many who say what they think with such confidence it's hard to tell if they really know what they're talking about. I don't know if admissions committees select for this type of confidence or if it's due to the nature of the ridiculously sized knowledge base required in medicine. But I can't count the number of times I've been fed some information by someone, only to look it up later and find out it was wrong. This has even happened to me asking lecturers questions after class. I find it very frustrating and makes me very wary of trusting colleagues I don't know very well.

I think some people don't realize how refreshing it can be to hear an honest "I don't know". In general I find that I only trust people whom my questions can stump at least some of the time. A lot of people in my class come to me with questions and I take pride in the fact that if I'm not 110% sure of my opinion I will always say "I'm only X% sure about that."

...

anyway sorry for the derail and stupid rant... i guess i just had to get that out of my system.

 

[neutropeniaboy]

I've noticed a funny thing about medicine.

When I started, I recognized that I didn't know anything. When I was a young pup in residency, oh PGY-3 or so, I thought I knew everything.

Now, I'm back to the former.

Bummer.

 

[drivesmecraazee]

Not trying to pile onto the original responder so much as I am agreeing with resxn's general point. I used to be an engineer (still a lowly MSII) and probably the most annoying thing I've found about this field is the relative abundance of fake know-it-alls. I don't mind the real know-it-alls (humbling) and even the know-nothings who are honest.

What's tough is that there are so many who say what they think with such confidence it's hard to tell if they really know what they're talking about. I don't know if admissions committees select for this type of confidence or if it's due to the nature of the ridiculously sized knowledge base required in medicine. But I can't count the number of times I've been fed some information by someone, only to look it up later and find out it was wrong. This has even happened to me asking lecturers questions after class. I find it very frustrating and makes me very wary of trusting colleagues I don't know very well.

I think some people don't realize how refreshing it can be to hear an honest "I don't know". In general I find that I only trust people whom my questions can stump at least some of the time. A lot of people in my class come to me with questions and I take pride in the fact that if I'm not 110% sure of my opinion I will always say "I'm only X% sure about that."

...

anyway sorry for the derail and stupid rant... i guess i just had to get that out of my system.

What's up?? Im a MSII myself, Im costarrican so the system here is quite different...but according to the classes Im taking I could say Im a MSII. What you just said is very true, it happened to me thousands of time, even with teachers.

 

[TheThroat]

What's up?? Im a MSII myself, Im costarrican so the system here is quite different...but according to the classes Im taking I could say Im a MSII. What you just said is very true, it happened to me thousands of time, even with teachers.

Yes, it could take you thousands of time.

On another note (so to speak), operating on professional singers' TVC's is not for the faint of heart. I believe that Julie Andrews sued her laryngologist after surgery on her nodules. I don't know the details of the case, but personally wouldn't go near TVC nodules surgically unless they had failed months of voice therapy.

 

[Leforte]

I plan on sending any Professional Voice users to a fellowship trained laryngologist. While I don't feel a microflap is that challenging of a case, and would feel comfortable with many patients, I think that if the outcome is anything but perfect, the liability is too high with the professional voice.

 

[jymk83]

As far as I remember the papillomatous lesions on the
true vocal cords can be a cause for laryngeal carcinoma.
It's what they taught us in school .

 

[TheThroat]

As far as I remember the papillomatous lesions on the
true vocal cords can be a cause for laryngeal carcinoma.
It's what they taught us in school .

Technically, laryngeal papillomas would not be a "cause" of carcinoma. They can be, in rare cases, pre-malignant lesions. In a quick pubmed search, saw one article that quoted a 4 % malignant transformation rate.