Vocal nodules are benign, symmetric areas of thickening on the medial edge of the vocal folds, usually at the junction of the anterior and middle one third of vocal cords. Patients frequently report that symptoms of hoarseness, throat discomfort and easy vocal fatigue gradually increase throughout the day. Most patients respond to voice rest and speech therapy, but surgery may be necessary in selected cases. Vocal cysts are also benign lesions occurring on the edge of the vocal folds, but cysts are usually unilateral and require surgical excision. Vocal polyps are unilateral pedunculated lesions that occur predominantly in men and are associated with smoking and vocal abuse.
Vocal polyps result in hoarse, rough, low-pitched speech and usually require surgery.
Changes in air pressure in the ear may result in barotrauma if the normal function of the eustachian tube is compromised. The most common situation is airline travel in a person with inflammation, but scuba diving can also produce significant barotrauma. Patients complain of ear pain and loss of hearing. Uncompensated air pressure changes cause distortion and increased vascularization of the tympanic membrane followed by edema of the middle ear mucosa and even bleeding into the middle ear. Rapid air pressure changes may result in perforation of the tympanic membrane.