Q: My 8 and a half years old daughter is suffering from singer nodes or nodules on her vocal cords. She is not able to talk in full volume due to that. Doctor advised complete voice rest for two weeks, after which there was improvement. The doctor has advised extreme cautions to be taken. How serious is this disease? At times she has to take extra efforts to speak and she has a bulge in her neck - somewhat similar to goitre. Please advise.

A:The nodules in the larynx are seen in children if they shout or cry a lot. Shouting and whispering put strain on the vocal cords so should be avoided. Too much of coughing and clearing of the throat is also not good for the throat. Normal conversation in low tones is to be encouraged. She should avoid dusty environment. Steam inhalation with tincture benzoin drops added in the water helps. If the child is co-operative certain speech therapy exercises may be tried. Long lasting firm nodules may need removal but emphasis should be on vocal hygiene and speech therapy.