Nodules are common vocal cord lesions that typically result from vocal overuse or misuse. By definition they are bilateral, meaning they occur on both vocal cords directly opposite each other. Therefore, nodules are always plural. Nodules are like “calluses” that result from chronic abnormal friction between the cords. Over time these raised “bumps” on the cords affect how well the vocal cords can vibrate during phonation. Nodules result in the cords incompletely closing during phonation so patients’ voices often sound airy or breathy and pitch breaks are common. Singers may notice their upper register is erratic or absent.
Vocal cord nodules can occur in all age groups affecting both men and women. They appear more commonly in young boys before puberty, but beginning during the teenage years, nodules are far more common in women. Persons most affected or susceptible to develop nodules talk a lot or have vocally demanding jobs.
Like many voice disorders, nodules are best diagnosed by an experienced ENT who can perform a laryngoscopy or stroboscopy to directly look at the vocal cords. This is a simple and painless in-office procedure. Of note, it’s worth mentioning that many vocal cord masses are incorrectly labeled as “nodules.” It’s important to be evaluated by experienced ENTs who understand vocal lesions to make the correct diagnosis and ensure nodules are not mistaken for other common problems like cysts or polyps that are distinctly different.
Recommended treatment of vocal nodules is typically voice therapy and rarely requires surgery. Voice therapists help identify the underlying behavioral problems that created the nodules in the first place. By modifying how one uses their voice and creating healthy vocal habits, nodules usually resolve on their own.