Vocal nodules are thick calluses that form on the vocal folds. Nodules develop at the point of maximal contact of the vocal folds. They form to protect underlying delicate vocal tissue from repeated trauma. Vocal nodules are also known as teachers nodes, singer’s nodes, and screamer’s nodes.

No, vocal cord nodules are benign. They are composed of normal, non-cancerous, thickened vocal fold lining. Nodules are the body’s way of protecting the vocal folds from repeated trauma.

Repeated vocal fold trauma will lead to nodule formation. This trauma can come in many forms but most commonly results from improper voice technique such as shouting and straining during singing or speaking too long. Improper vocal muscle use, called muscle tension dysphonia, will cause vocal strain and overly forceful closure. This is the most common cause of nodules. Additional conditions that can contribute to nodule formation include chronic allergies, acid reflux disease, and smoking.

Typically, vocal nodules will cause a progressive decrease in voice quality. Some patients describe their voice as sounding hoarse, breathy, and rough. Most patients will notice decreased vocal range and vocal fatigue. These changes are typically reversible if addressed promptly. If left untreated, vocal cord nodules may permanently impact voice.

The gold standard treatment for vocal nodules is voice therapy from a skilled vocal therapist. These specialists work with patients to modify their method of voice use, promote vocal fold healing, and correct harmful vocal habits. In addition, a vocal therapist can customize a treatment plan around a patient’s unique demands. Treating other contributing conditions (such as GERD, allergies, etc) may help to slow the progression or recurrence of these lesions.

Vocal nodules can improve with voice rest but will recur when the voice user reengages the voice in the behaviors that led to the nodules. Nodules do not typically resolve on their own without addressing the conditions or vocal technique that initially caused them.

In most cases surgery is not the optimal treatment for vocal cord nodules and should be reserved for longstanding nodules that are unaffected by voice therapy. Most nodules can be treated with voice therapy. However, we use latest surgical techniques with microscope and lasers that have had significant success at nodule treatment followed by voice therapy which helps inpreventing the reformation of the nodules.

Nodule recurrence is high unless the conditions that initially led to them, such as improper vocal technique, are addressed. Voice therapy is essential in identifying and correcting harmful vocal techniques.