Vocal Cord Polyps and Nodules

I have recently worked with an individual who came to our office for voice therapy secondary to severe vocal nodules. I found this case to be extremely interesting and it inspired this weeks blog topic.  Below you will find information about what vocal nodules and polyps are, what causes them, and the harmful effects they can have on your voice. I hope you find this interesting!


What are vocal cord nodules and polyps?

Vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse. Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues.

Polyps can take a number of forms. They are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal cords. They appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke’s edema. The best way to think about the difference between nodules and polyps is to think of a nodule as a callous and a polyp as a blister.

What are signs and symptoms of vocal cord nodules or polyps?

Nodules and polyps cause similar symptoms:

  • hoarseness
  • breathiness
  • a “rough” voice
  • a “scratchy” voice
  • harshness
  • shooting pain from ear to ear
  • a “lump in the throat” sensation
  • neck pain
  • decreased pitch range
  • voice and body fatigue

How are nodules and polyps diagnosed?

If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include:

  • a physician’s examination, preferably by an otolaryngologist (ear, nose, and throat doctor) who specializes in voice,
  • a voice evaluation by a speech-language pathologist (SLP), and
  • possibly a neurological examination.

The team will evaluate vocal quality, pitch, loudness, ability to sustain voicing, and other voice characteristics. An instrumental examination may take place that involves inserting an endoscope into the mouth or nose to look at the vocal cords and larynx in general. A stroboscope (flashing light) may be used to watch the vocal cords as they move.

What treatments are available for nodules and polyps?

Nodules and polyps may be treated medically, surgically, and/or behaviorally. Surgical intervention involves removing the nodule or polyp from the vocal cord. This approach only occurs when the nodules or polyps are very large or have existed for a long time. Surgery is rare for children. Medical problems may be treated to reduce their impact on the vocal cords. This includes treatment for gastroesophageal reflux disease (GERD), allergies, and thyroid problems. Medical intervention to stop smoking or to control stress is sometimes needed.

Many people receive behavioral intervention, or voice therapy, from an SLP. Voice therapy involves teaching good vocal hygiene, reducing/stopping vocal abusive behaviors, and direct voice treatment to alter pitch, loudness, or breath support for good voicing. Stress reduction techniques and relaxation exercises are often taught as well.

What causes nodules and polyps?

Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by long-term vocal abuse but may also occur after a single, traumatic event to the vocal cords, such as yelling at a concert. Long-term cigarette smoking, hypothyroidism, and GERD may also cause polyp formation. Below are some vocally abusive behaviors:

  • allergies
  • smoking
  • tense muscles
  • singing
  • coaching
  • cheerleading
  • talking loudly
  • drinking caffeine and alcohol (dries out the throat and vocal cords)




Information retrieved from: http://www.asha.org/public/speech/disorders/NodulesPolyps/



Preschool Language Disorder

Over the past few months I have seen more and more preschool age children coming to our office for language evaluations. Many of these evaluations have been due to parental concerns with their child’s inability to communicate with age-matched peers, as well as express their feelings, wants, and needs.   Below you will find some information about preschool language disorders, their causes, and what can be done to help a child who suffers from a language disorder… ENJOY!!

What are preschool language disorders?

Children with preschool language disorders often have trouble understanding and talking.

What are some signs or symptoms of preschool language disorders?

Some children have problems with understanding, (receptive language), these individuals have difficulties with:

  • Understanding what gestures mean
  • Following directions
  • Answering questions
  • Identifying objects and pictures
  • Taking turns when talking with others

Some children have problems talking, (expressive language), these individuals have difficulties with:

  • Asking questions
  • Naming objects
  • Using gestures
  • Putting words together into sentences
  • Learning songs and rhymes
  • Using correct pronouns, like “he” or “they”
  • Knowing how to start a conversation and keep it going

Not only do children display difficulties with expressive and receptive language, but parents and teachers may observe difficulties with reading and writing.  Some of these difficulties include:

  • Holding a book right side up
  • Looking at pictures in a book and turning pages
  • Telling a story with a beginning, a middle, and an end
  • Naming letters and numbers
  • Learning the alphabet

How are preschool language disorders evaluated?

Speech-language pathologists, also called SLPs, usually are part of a team. The team includes you, the child’s teacher, and other professionals. The team can see if your child’s language skills are at age level. SLPs evaluate children while they play. They want to know:

Some of the areas that may be assessed/ looked into are:

  • Follows directions
  • Names common objects and actions
  • Knows colors, numbers, and letters
  • Follows routines like putting his coat away or sitting during circle time
  • Sings songs or repeats nursery rhymes
  • Gets needs met at home, during play, and at preschool

SLPs will see if your child’s speech is easy to understand. They will see how your child uses her lips, tongue, and teeth to make sounds. They will have your child imitate sounds or words.

For early reading and writing, the SLP will see if your child:

  • Looks at and talks about pictures in books
  • Recognizes familiar signs and logos
  • Holds a book correctly and turns the pages
  • Recognizes and writes his or her own name
  • Tries to write letters and numbers

How are preschool language disorders treated?

SLPs can help children with language disorders. They work on language problems found during the evaluation. They work with you, teachers, and other professionals to improve speech and language skills. Good language skills help with learning, behavior, self- esteem, and social skills.

Here are some possible treatment goals:

  • Increase your child’s understanding and use of language
  • Teach caregivers, family members, and teachers ways to communicate with your child
  • Help your child use other ways to communicate when needed. This may include simple gestures, picture boards, or computers that say words out loud. This is also called augmentative and alternative communication, or AAC.

What can I do to help?

Here are some language tips:

  • Talk a lot your child. This will help your child learn new words.
  • Read to your child every day.
  • Point out words you see. Point to signs in the grocery store, at school, and outside.
  • Speak to your child in the language you know best.
  • Listen and respond when your child talks.
  • Encourage your child to ask you questions.
  • Give your child time to answer questions.
  • Set limits for watching TV and using electronic media. Use the time for talking and reading together.

What causes preschool language disorders?

Often the cause of a language disorder in not known. Some causes of preschool language disorders may be:

  • Family history of language disorders
  • Premature birth
  • Low birth-weight
  • Hearing loss
  • Autism
  • Intellectual disabilities
  • Syndromes, like Down syndrome or Fragile X syndrome
  • Fetal alcohol spectrum disorder
  • Stroke
  • Brain injury
  • Tumors
  • Cerebral palsy
  • Poor nutrition
  • Failure to thrive

What are the types of preschool language disorders?

Problems with understanding are called receptive language disorders. Problems with talking are called expressive language disorders. Children may have problems with both. Sometimes a language disorder is called specific language impairment, or SLI.

Types of preschool language disorders may include problems with:

  • Understanding basic concepts, questions, and directions
  • Learning new words
  • Saying words in the right order
  • Having conversations and telling stories


Information obtained from: http://www.asha.org/public/speech/disorders/Preschool-Language-Disorders/

Selective Mutism

For this weeks post I will be discussing Selective Mutism.  Selective mutism typically occurs during childhood years. A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends.

What are some signs or symptoms of selective mutism?

Symptoms are as follows:

  • consistent failure to speak in specific social situations despite speaking in other situations.
  • not speaking interferes with school or work, or with social communication.
  • lasts at least 1 month (not limited to the first month of school).
  • failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
  • not due to a communication disorder (e.g., stuttering). It does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder.

Children with selective mutism may also show signs of anxiety, shyness, embarrassment or social isolation.

How is selective mutism diagnosed?

A child with selective mutism should be seen by a speech-language pathologist (SLP), in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual.

The educational history review seeks information on:

  • academic reports
  • parent/teacher comments
  • previous testing
  • standardized testing

The hearing screening seeks information on:

  • hearing ability
  • possibility of middle ear infection

The oral-motor examination seeks information on:

  • coordination of muscles in lips, jaw,and tongue
  • strength of muscles in the lips, jaw, and tongue

The parent/caregiver interview seeks information on:

  • any suspected problems (e.g., schizophrenia, PDD, etc.)
  • environmental factors
  • child’s amount and location of verbal expression/ interaction with others
  • child’s symptom history (e.g. onset of behaviors)
  • family history
  • speech and language development

The speech and language evaluation seeks information on:

  • expressive language ability
  • language comprehension
  • verbal and non-verbal communication

What treatments are available for individuals with selective mutism?

The type of intervention offered will differ depending on the needs of the child  The child’s treatment may use a combination of techniques, depending on individual needs.

A behavioral treatment program may include the following:

  • Stimulus fading: involve the child in a relaxed situation with someone they talk to freely, and then gradually introduce non familiar listeners.
  • Shaping: use a structured approach to reinforce all efforts by the child to communicate, until audible speech is achieved
  • Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs

If specific speech and language problems exist, the SLP will:

  • target problems that are making the mute behavior worse;
  • use role-play activities to help the child to gain confidence speaking to different listeners in a variety of settings; and
  • help those children who do not speak because they feel their voice “sounds funny”.

Work with the child’s teachers includes:

  • encouraging communication and lessen social anxiety
  • forming small social groups that are less intimidating
  • helping the child communicate with peers in a group by first using non-verbal methods and gradually adding goals that lead to speech
  • working with the child, family, and teachers to generalize learned communication behaviors into everyday living


Hope you found this weeks post interesting!



Information retrieved from: http://www.asha.org/public/speech/disorders/SelectiveMutism.htm#2


For this weeks blog I will be discussing a motor speech disorder known as Dysarthria. Dysarthria is a type of disorder that causes individuals to experience weakness and slow movements of the muscles of the mouth, face, and respiratory system.  The type and severity of dysarthria all depends on which area of the nervous system is affected.

What are some signs or symptoms of dysarthria?

A person with dysarthria may experience any of the following symptoms:

  • “Slurred” speech
  • Speaking softly or barely able to whisper
  • Slow rate of speech
  • Rapid rate of speech with a “mumbling” quality
  • Limited tongue, lip, and jaw movement
  • Abnormal intonation (rhythm) when speaking
  • Changes in vocal quality (“nasal” speech or sounding “stuffy”)
  • Hoarseness
  • Breathiness
  • Drooling or poor control of saliva
  • Chewing and swallowing difficulty

How is dysarthria diagnosed?

A speech-language pathologist (SLP) can evaluate a person with speech difficulties and determine the nature and severity of the problem. The SLP will look at movement of the lips, tongue, and face, as well as breath support for speech, voice quality, and more.

Another motor speech disorder is apraxia.. An important role of the SLP is to determine whether the person’s speech problems are due to dysarthria, apraxia, or both.  Being aware of the differences between dysarthria and apraxia are important for differential diagnosis.

Dysarthria: Dysarthric errors result from a disruption of muscular control due to lesions of either the central or peripheral nervous systems. In other words, there is an interruption in the transmission of messages controlling the motor movements for speech. Because it involves problems with the transfer of information from the nervous system to the muscles, dysarthria is classified as a neuromotor disorder.

Apraxia: Apraxia results from difficulties generating the motor programs for speech movements rather than from the disordered transmission of controlling messages to the speech musculature. Apraxia is a planning/programming problem, not a movement problem like dysarthria.

What treatment is available for people with dysarthria?

Treatment depends on the cause, type, and severity of the symptoms. SLP’s work in a variety of settings with  dysarthric individuals and works to improve communication abilities.

Possible Goals of Treatment

  • Slowing the rate of speech
  • Improving the breath support to increase vocal volume
  • Strengthening muscles
  • Increasing rang of motion of the mouth, tongue, and lips
  • Improving articulation so that speech is more clear
  • Educating caregivers, family members, and teachers about ways to better communicate with the person with dysarthria
  • Learn to use alternative forms of communication (e.g., simple gestures, alphabet boards, or electronic or computer-based equipment)

Below are some tips that can be used when communicating with an individual with dysarthria:

Tips for the Person With Dysarthria

  • Introduce your topic with a single word or short phrase before beginning to speak in more complete sentences
  • Remember to frequently check with listeners to make sure that they understand you
  • Speak slowly and loudly; pause frequently
  • Try to limit conversations when you feel tired, speech is often difficult to understand when not well rested
  • Other methods of communication can be used in conversation, such as pointing or gesturing, to get your message across, or take a rest and try again later

Children may need additional help to remember to use these strategies.

Tips for the Listener

  • Reduce distractions and background noise
  • Pay attention to the speaker
  • Watch the person as he or she talks
  • Let the speaker know when you have difficulty understanding him or her
  • Repeat only the part of the message that you understood so that the speaker does not have to repeat the entire message
  • If you still don’t understand the message, ask yes/no questions or have the speaker write his or her message to you

What causes dysarthria?

Dysarthria is caused by many different conditions that involve the nervous system, including the following:

  • Stroke
  • Brain injury
  • Tumors
  • Cerebral palsy
  • Parkinson’s disease
  • Lou Gehrig’s disease/amyotrophic lateral sclerosis (ALS)
  • Huntington’s disease
  • Multiple sclerosis
  • Medications

Hope you found this post interesting!




Orofacial Myofunctional Disorders (OMD)

Children’s speech and language development follows a typical pattern.  There are many speech and language disorders affecting both children and adults today. Throughout the month of December I am going to be discussing many of the different disorders commonly seen in our practice.  Over the past few weeks I have seen many evaluations completed in our office regarding concerns with expressive speech deficits secondary to an abnormal, anterior tongue placement.  These evaluations have inspired me to write this weeks blog on Orofacial Myofunctional Disorders (OMD). 


What are orofacial myofunctional disorders (OMD) ?

Orofacial myofunctional disorders cause an abnormal, anterior tongue mvoement during speech and/or swallowing.  The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and also at rest. 

What are some signs and symptoms of OMD?

Although anterior tongue movements during a swallow is normal in infancy, it usually decreases and disappears as a child grows. If these anterior movements continue, a child may look, speak, and swallow differently than other children of the same age. Older children and/or adults may become self-conscious about their appearance.

What effect does OMD have on speech?

Some children produce sounds incorrectly as a result of OMD. OMD most often causes sounds like /s/,/z/, “sh”, “zh”, “ch” and “j” to sound differently. For example, the child may say “thumb” instead of “some” if they produce an /s/ like a “th”. Also, the sounds /t/, /d/, /n/, and /l/ may be produced incorrectly because of weak tongue tip muscles. Sometimes speech may not be affected at all.

How is OMD diagnosed?

OMD is often diagnosed by a team of professionals. In addition to the child and his or her family or caregivers, the team may include:

  • a dentist
  • an orthodontist
  • a physician
  • a speech-language pathologist (SLP)

Both dentists and orthodontists may be involved when constant, continued tongue pressure against the teeth interferes with normal tooth eruption and alignment of the teeth and jaws. Physicians rule out the presence of a blocked airway (e.g., from enlarged tonsils or adenoids or from allergies) that may cause forward tongue posture. SLPs assess and treat the effects of OMD on speech, rest postures, and swallowing.

What treatment is available for individuals with OMD?

A speech-language pathologist (SLP) with experience and training in the treatment of OMD will evaluate and treat the following:

  • open-mouth posture
  • speech sound errors
  • swallowing difficulties

SLPs develop a treatment plan to help a child change his or her oral posture and articulation, as well as an individuals deviant swallow pattern.

Treatment techniques to help both speech and swallowing problems caused by OMD may include the following:

  • increasing awareness of mouth and facial muscles
  • increasing awareness of mouth and tongue postures
  • improving muscle strength and coordination
  • improving speech sound productions
  • improving swallowing patterns

If airways are blocked due to enlarged tonsils and adenoids or allergies, speech treatment may be postponed until medical treatment for these conditions is completed. If a child has unwanted oral habits (e.g., thumb/finger sucking, lip biting), speech treatment may first focus on eliminating these behaviors. In addition, if orthodontic work is deemed necessary (i.e. palate expander and/or habit breaker), treatment may be postponed until treatment is completed.

What causes OMD?

The following may cause OMD:

  • allergies
  • enlarged tonsils and adenoids
  • excessive thumb or finger sucking, lip and fingernail biting, lip picking, and teeth clenching and grinding
  • family heredity

Allergies can cause problems with the functioning of the mouth or face muscles. For children with allergies, it is often hard to breath normally through the nose because of nasal airway blockage. They often breath with their mouths open, tongues lying flat on the bottom of their mouths. Lip muscles may lose their strength and tone if an open-mouth posture continues for a long time.

Enlarged tonsils and adenoids can block airways, causing an open-mouth breathing pattern. This pattern can become habit forming and continue even after medical treatment for the blocked airway is received.

Excessive thumb or finger sucking, lip and fingernail biting, lip picking, and teeth clenching and grinding can result in OMD. Constant thumb sucking in particular may change the shape of the child’s upper and lower jaw and teeth, requiring speech, dental, and orthodontic intervention.  Oral fixations can change the size and shape of the palate, causing the tongue to no longer fit in the confines of the mouth, resulting in incorrect tongue placement. These fixations should be completely eliminated before therapy begins.

Family heredity can be involved in determining the size of a child’s mouth, the arrangement and number of teeth, and the strength of the lip, tongue, mouth, and facial muscles.

Hope you found this interesting!!