The Case for Vocal Checkups

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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 symptoms.

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.