The Case for Vocal Checkups by Françoise P. Chagnon
/ April 1, 1998
How many singers know that a rough voice in just part of the
range may be due to very small localized swellings in the vocal
cords? Few do, and it is one reason to have periodic checkups making
use of the latest imaging technology.
Laryngeal stroboscopy -- a harmless imaging technique employing a
thin fibre-optic tube in the throat -- has recently become widely
available in clinical practice. This instrument has shown that small
benign lesions within the folds of the vocal cords are often present
without causing noticeable voice complaints.
Certain small lesions, such as a swollen nodule or polyp, may be
so slight that vocal fold vibration and closure are only minimally
impaired. The singer perceives some roughness in certain areas of
the vocal range but does not usually suspect a mechanical problem
such as swelling.
In such cases a clear voice can be obtained by making a greater
expiratory effort. Most singers have had the neuromuscular vocal
training that allows them to compensate for minimal vocal fold
disorders. Unfortunately this compensation does not correct the
underlying problem and may actually aggravate it, as has been
explained in an earlier column. It is far better to receive an
accurate diagnosis and take appropriate steps, i.e. vocal rest and
removal of irritants.
The ability of laryngeal stroboscopy to identify even very small
lesions in the folds of the vocal cords gives it value to apparently
healthy singers as well as to symptomatic ones. If no lesions are
found, then the first examination serves as a baseline for future
examinations when the singer has a complaint. If small lesions are
found, then they can be tracked over time. Since benign lesions
commonly evolve, growing larger or fading away, these changes can be
compared to patterns of voice use and a number of known physiologic
factors. Sequential examinations are then helpful in establishing
the causality, if any, between vocal fold lesions and voice
The occurrence of
small benign lesions is common and does not carry a gloomy
prognosis. Most disappear on their own, provided the singer listens
carefully to his or her voice and takes enough rest to allow any
overworked and irritated tissues to return to their normal state. A
periodic checkup employing laryngeal stroboscopy may help more
vulnerable singers to keep their vocal cords on track.