Polyps and Nodules

Dr. Morton Cooper reports outstanding results from using Direct Voice Rehabilitation (DVR) with Nodules, Polyps, and Polypoid Degeneration.

Dr. Cooper’s success and cures of this condition were detailed in his textbook Modern Techniques of Vocal Rehabilitation in 1973. From that time on, Dr. Cooper reports faster results because of discoveries he has made with locating the right pitch of voice, the right placement of voice, the better way to breathe right for speaking, and focusing in on the voice image and voice identity, which he finds are all key to successful voice rehabilitation.

Overview of Nodules, Polyps, and Polypoid Degeneration

Nodules and polyps, which are benign vocal fold growths, may be unilateral or bilateral. Usually they are located on the anterior third of the vocal folds.

Nodules are generally sessile; polyps are either sessile or pdeunculated. The terms node and nodule are often used interchangeably.

Polypoid degeneration is a series or extension of polyps which may be located on a portion of the vocal fold or on the entire vocal fold, either unilaterally or bilaterally. Although laryngeal pain is usually associated with contact ulcer, patients with nodules and with polypoid degeneration have also complained of pain in this area.

Causes of Nodules, Polyps, and Polypoid Degeneration

The effect of voice misuse and abuse on the causation of vocal fold nodules, polyps, and polypoid degeneration has been previously discussed. The total treatment program, including the appropriateness of a surgical procedure, has also been included.

Some postsurgical patients who have undergone unilateral or biolateral stripping of the vocal folds for polypoid degeneration experience marked difficulty in securing or regaining a normal voice. A study by Dr. Cooper (1972), in comparing patients with nodules, polyps, and contact ulcers, found that the mean fundamental frequencies of postoperative groups (growth removed by surgery) were lower than the mean fundamental frequencies of no surgery groups (growth present; no surgery) both males and in females prior to voice rehabilitation.

Treatments for Nodules, Polyps, and Polypoid Degeneration

Voice therapy for these lesions is similar to the procedure previously outlined. Only one point needs further discussion because of the controversy which exists regarding the change of pitch in cases of vocal fold nodules. Some authors, such as Wilpitch in cases of vocal fold nodules. Some authors, such as Wilson (1966) and Van Riper and Irwin (1958), have recommended lowering the pitch usually.

A review of Dr. Cooper’s patients who had nodules as well as those patients having polyps and polypoid degeneration reveals that these patients had a long history of utilizing the basal or near basal pitch of voice. The pitch nearly always needed to be raised.

In agreement are Fisher and Logemann who report:

Our clinical experience has led to concurrence with Luchsinger and Arnold’s observation of an unnaturally low speaking pitch in many nodule patients. (1970, p. 277)

They have also found:

Further, the case histories of many such patients suggested that use of an unnaturally low speaking pitch was a habit before the dysphonia begun and might be credited, at least in part, with contributing to the development of the lesion. (p. 278)

The vast majority of patients seen with nodule by Dr. Cooper were using the basal or near basal pitch of voice. Nodules have been the most frequently seen organic condition.

Luchsinger and Arnold have also found:

The voice nodule is the commonest chronic, though benign, laryngeal lesion removed surgically for diagnosis and therapy. (1965, p. 179)

Clinical Study

Spectrographic analysis was used as a clinical tool to describe and compare fundamental frequencies and hoarseness in dysphonic patients before and after vocal rehabilitation and to evaluate a technique for locating the natural or optimal pitch level.

The results indicated that 150 out of 155 patients were using too low a pitch before therapy. Before therapy, varying degrees of hoarseness were found in all 27 patients. After therapy, the patients were basically free of hoarseness.

Three months to seven years after the completion of vocal rehabilitation, 98% of the 128 patients who were re-examined had remained excellent or good. (“Spectrographic Analysis of Fundamental Frequency and Hoarseness Before and After Vocal Rehabilitation,” Journal of Speech and Hearing Disorders, 39 [August 1974], 286-297.)

Clinical Results

Of the 254 patients seen with nodules, the following conclusions may be drawn:

  1. Of the 254 patients seen, 190 (74.8%) entered therapy.
  2. Of the 190 patients entering therapy, 178 (93.7%) completed therapy.
  3. Of the 178 patients completing therapy, 48 (27%) had long-term therapy and 130 (73%) had short-term therapy.
  4. Of the 178 patients completing therapy, the results were: 125 (70.2%) excellent, 29 (16.3%) good, and 24 (13.5%) fair.
  5. The comparison between males and females seen: 107 (42.1%) males and 147 (57.9%) females.

Of the 68 patients seen with polyps, the following conclusions may be drawn:

  1. Of the 68 patients seen, 51 (75%) entered therapy.
  2. Of the 51 patients entering therapy, 46 (90.2%) completed therapy.
  3. Of the 46 patients completing therapy, 9 (19.6%) had long-term therapy and 37 (80.4%) had short-term therapy.
  4. Of the 46 patients completing therapy, the results were: 27 (58.7%) excellent, 9 (19.6%) good, and 10 (21.7%) fair.
  5. The comparison between males and females seen: 25 (36.8%) males and 43 (63.2%) females.

Of the 63 patients seen with polypoid degeneration, the following conclusions may be drawn:

  1. Of the 63 patients seen, 40 (63.5%) entered therapy.
  2. Of the 40 patients entering therapy, 35 (87.5%) complete therapy.
  3. Of the 35 patients completing therapy, 8 (22.9%) had long-term therapy and 27 (77.1%) had short-term therapy.
  4. Of the 35 patients completing therapy, the results were: 23 (65.7%) excellent, 8 (22.9%) good, and 4 (11.4%) fair.
  5. The comparison between meals and females seen: 12 (19%) males and 51 (81%) females.

Testimonials

A few testimonials from former Nodule, Polyps and Polypoid Degeneration patients: