User:Flavafee/sandbox

Article evaluation
I am evaluating the Wikipedia article on vocal cord nodules. My comments are as follows: I find the introduction section to this article very dense. It also has information that I believe would be more appropriate in a subsection; for example, it begins talking about diagnosis before even really defining what vocal cord nodules are. Also, the terms "vocal folds" and "vocal cords" are being used interchangeably: even the first words of the article do not match the title! In the coming weeks I will make changes that I hope address these issues.

Edit (2018-11-03): In the end, I decided to add mostly to the Behavioural Treatment section, as I found a good systematic review of the effects of nonmedical treatments of vocal fold nodules.

Vocal Cord Nodules
Vocal cord nodules (also known as vocal fold nodules, or simply vocal nodules) are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds. Although diagnosis involves a physical examination of the head and neck, as well as perceptual voice measures, visualization of the vocal nodules via laryngeal endoscopy remains the primary diagnostic method. Vocal fold nodules interfere with the vibratory characteristics of the vocal folds by increasing the mass of the vocal folds and changing the configuration of the vocal fold closure pattern. Due to these changes, the quality of the voice may be affected. As such, the major perceptual signs of vocal fold nodules include vocal hoarseness and breathiness. Other common symptoms include vocal fatigue, soreness or pain lateral to the larynx, and reduced frequency and intensity range. Airflow levels during speech may also be increased. Vocal fold nodules are thought to be the result of vocal fold tissue trauma caused by excessive mechanical stress, including repeated or chronic vocal overuse, abuse, or misuse. Predisposing factors include profession, gender, dehydration, respiratory infection, and other inflammatory factors.

Treatment
The two main methods of treating vocal fold modules are voice therapy (a behavioural treatment) and laryngeal microsurgery (a surgical treatment. Because of general risks of surgery (e.g. scar formation, or those posed by general anesthesia ), behavioural treatment is usually recommended first.

Behavioural treatment
Behavioural voice therapy is typically carried out by speech-language pathologists. While behavioural treatments methods vary greatly, they are generally effective at improving vocal quality and decreasing size of vocal fold nodules. Complete resolution of nodules through behavioural treatment is possible but unlikely.

Behavioural techniques can indirect or direct. Indirect approaches focus on improving vocal hygiene, introducing and/or maintaining safe voice practices (thereby reducing opportunities for phonotrauma) and, occasionally, implementing vocal rest. Direct approaches involve reducing the physiological strain on the vocal system while the voice is being used (e.g. during speaking or singing), such as by reducing collision forces between the vocal folds, ensuring sufficient pulmonary support while speaking (e.g. by changing the individual's breathing pattern), and optimizing resonance of the larynx and other structures of the vocal apparatus.

Behavioural treatments also vary in delivery model. Traditional therapy distribution (e.g. eight sessions within eight weeks), more intensive approaches (e.g. eight session within three weeks) and remote therapy (i.e. telehealth) have all shown effectiveness in treating vocal fold nodules.

Assessment of outcomes of behavioural treatments also varies greatly. Effects can be measured visually (e.g. by the same methods typically used to confirm the presence of vocal fold nodules: video endoscopy and video stroboscopy ), aerodynamically (e.g. by measuring parameters such as transglottal pressure and the glottal airflow waveform ), perceptually (e.g. by rating the voice in terms of dimensions such as roughness, breathiness, aesthenia and strain ), in terms of effect on quality of life measures, or using any combination of the above.

Finally, recurrence of vocal fold nodules after behavioural treatment is always a possibility, particularly if nodules were not completely resolved or if skills gained during treatment were not carried-over outside of therapy sessions or maintained after therapy blocks.