A young teacher presents with bilateral symmetric sessile swellings at the junction of the anterior and middle thirds of the vocal cords after a semester of heavy voice use. Stroboscopy reveals mucosal wave disruption and incomplete glottic closure at the lesion site. Histology shows hyalinised subepithelial fibrous tissue. What is the FIRST-LINE treatment?
- A Immediate microlaryngoscopy and excision under general anaesthesia
- B Voice therapy (vocal hygiene, resonant voice techniques) for 3-6 months before considering surgery ✓
- C Botulinum toxin injection into the thyroarytenoid muscles bilaterally
- D Intralesional corticosteroid injection under laryngoscopic guidance
Explanation
Vocal cord nodules (teacher's/singer's nodules) at the anterior-middle third junction develop from repetitive phonotrauma. First-line management is voice therapy — including vocal hygiene counselling (adequate hydration, avoidance of throat clearing), and techniques such as resonant voice therapy or Lessac-Madsen resonant voice therapy. Surgery (microlaryngoscopic excision) is reserved for nodules that fail to resolve after 3-6 months of compliance-verified voice therapy. Early surgery is avoided because the nodules are a response to phonotrauma and will recur without behaviour modification.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.