In the last seven or eight months, my voice has been getting more and more hoarse. It doesn't hurt. An ENT diagnosed me as having two small nodules, or polyps, on my vocal cords. He said I probably wasn't using my voice well and that allergies were aggravating the problem. He prescribed a nasal steroid spray and voice lessons. His recommendations sound kind of goofy to me. Is there anything you can tell me about this? Where is a good place to get more information?

P.D.

It worries me that your ENT (ear, nose and throat specialist) said you had "two small nodules, or polyps." Nodules and polyps are two very different animals. If your ENT does not know the difference between these two diagnoses, he or she may not be recommending the best treatment for you.

Let's examine each diagnosis separately. Vocal nodules are also known as "screamer's nodules" or "singer's nodules." That should give you a fairly clear picture of what causes nodules: vocal abuse. In fact, most professional singers do not develop nodules because they have been taught how to use (and not abuse) their voice. Children, adults who often scream at their children and nonprofessional singers are much more likely to develop nodules.

Nodules do not respond to surgical treatment because the resulting scars are worse than the initial problem. Nodules do respond to speech therapy, however. Your allergies may be contributing to the problem, but it is more likely that you misuse your voice. Poor hydration (drinking too many caffeinated or alcoholic beverages and not enough water or juice) is another common contributing factor.

Vocal polyps are fleshy appendages that hang off the vocal cords like water bags. They are usually caused by chronic inflammation of the vocal cords. Once again, allergies or chronic sinusitis may contribute to the formation of vocal polyps, but more common culprits are cigarette smoke and chronic acid reflux. (Reflux occurs when stomach acids and digestive enzymes ascend the esophagus and spill over into the throat, often burning the vocal cords.) Unlike vocal nodules, polyps are best treated by surgical removal AND correction of the underlying problem (stop smoking, treat the reflux, etc.).

These conditions are best diagnosed by having an ENT examine your vocal cords using a fiber-optic viewing device called an endoscope. The doctor may also use a strobe light to illuminate the vocal cords because it shows them opening and closing in what looks like slow motion. Many ENT's are very good at examining the vocal cords using a small mirror placed in the back of the throat, but in my opinion this diagnosis is best made with the aid of fiber-optic scopes.

To learn more about these conditions, you might want to visit two websites, the Center for Voice Disorders and Voice Center. There's a great photo of vocal nodules right at the top of the Center for Voice Disorders homepage!