Vocal cord nodules

If people speak hoarsely, vocal cord nodules may be the reason. The voice of those affected can moreover sound toneless and rough. If the voice is rested or voice therapy performed, the benign nodules normally disappear again. Vocal cord nodules develop especially in people who speak or sing often and loudly.

At a glance

  • Vocal cord nodules typically cause hoarseness.
  • The voice can also sound toneless and throaty.
  • If the voice is rested or voice therapy performed, the benign nodules normally disappear again.
  • Vocal cord nodules develop especially in people who speak or sing often and loudly.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Vocal nodules (vocal cord nodules): woman in a green lab coat holding the model of a larynx in both hands.

What are vocal cord nodules?

If the voice is overstrained for a considerable time, vocal cord nodules can develop. The voice then sounds different, and those affected are hoarse.

If the voice is rested or voice therapy performed, the benign nodules normally disappear again. Only in very rare cases do they have to be surgically removed.

The vocal folds are two mucosal folds located approximately in the middle of the larynx. The vocal cords and vocalis muscles run along the edge of the vocal folds and help them move. The vocal folds move closely together for speaking or singing. Inhaled air causes the tissue to oscillate and sound is generated. If the vocal folds are overstrained, they swell up and nodules may form.

Important: Voice problems are not only caused by vocal cord nodules. Hoarseness is usually triggered by laryngitis. Furthermore, smoking and paralysis of the vocal folds can adversely affect the voice. In rare cases, a malignant tumor or psychiatric cause can cause voice problems.

What are the symptoms of vocal cord nodules?

Vocal cord nodules typically cause hoarseness. The voice can also sound toneless or throaty.

Those affected can moreover no longer carry a tune for as long as usual. Very high or low speaking and singing are also no longer possible.

What causes vocal cord nodules?

If the voice is overly strained, the mucosa and tissue below it swell up. As a result of the swelling, the vocal folds no longer fit together precisely. They oscillate irregularly during speaking or singing. The voice thus sounds changed, hoarse or fails entirely. Among other things, the voice can be overstrained by frequent or loud speaking. This can also happen in hearing impaired people who easily get into the habit of speaking loudly.

Babies and infants who cry a lot may also put too much strain on their vocal folds and thereby get vocal cord nodules.

If too much force is unwittingly expended during speaking on a constant basis, this severely strains the vocal folds, for instance in people who are highly stressed or always breathe in their chest and not their abdomen. Furthermore, poor posture can contribute to voice problems.

Anyone who works a lot with their voice in their job is more likely to get vocal cord nodules than people in other professions. In singers, vocal nodes are not only caused by frequent use of the voice, but also by poor singing techniques. The nodules are thus also called singer’s nodules or singer’s nodes. Teachers can also develop vocal nodes.

How common are vocal cord nodules?

Women and children are most commonly affected by vocal cord nodules. In children, they are one of the most common causes of hoarseness.

How do vocal cord nodules develop?

If the voice is overstrained, the edge of both vocal folds initially swells up – especially between the front and middle thirds. The vocal folds are strained most severely here. The swellings already cause initial voice problems. Furthermore, if too much strain is put on the voice, vocal cord nodules form in the swollen margins of the vocal folds. They are roughly the size of a pinhead and face each other.

Vocal cord nodules do not usually lead to serious complications. However, if they do not disappear, the symptoms may occur repeatedly if the voice is strained.

How can vocal cord nodules be prevented?

In particular, people who often talk or sing should occasionally give their voice enough time to rest. This may contribute to stopping any vocal cord nodules from developing.

If the voice gets tired quickly or becomes hoarse, voice therapy may be useful for preventing persistent voice problems. In voice therapy, people learn how to better manage their own posture and breathing, among other things. Furthermore, the therapy can help make the voice more resilient using voice and breathing exercises.

How are vocal cord nodules diagnosed?

A specialist can determine whether vocal cord nodules have formed. The right places to go are medical practices for ear, nose and throat medicine (ENT) or for speech disorders, vocal dysfunction and hearing disorders in children (phoniatrics and pediatric audiology). The vocal folds can be examined with the aid of a laryngoscopy. For this technique, the doctor uses a flexible or rigid endoscope (laryngoscope). This is a device that is inserted into the throat for examination. Sometimes the mucosa can be locally anesthetized.

Furthermore, the flexibility of the vocal folds can be inspected with the aid of special devices that magnify the vocal folds (like a magnifying glass). They are fitted with a small light that emits flashes at very short intervals (laryngostroboscope). The vocal folds thus appear to move in slow motion. This way, they can be observed more closely.

How are vocal cord nodules treated?

People with vocal cord nodules should take good care of their voice. If constant phone calls are the reason for instance, an attempt could be made to replace these with text messages on a mobile phone or computer. Parents with children who constantly cry can consult a pediatrician.

For older children and adults, voice therapy with a speech therapist is possible. Voice therapy teaches people how to protect their voice, relax and improve their posture. They also learn how to coordinate speaking and breathing.

You can find more detailed information, for example about how voice therapy works, at gesundheitsinformation.de.

Vocal nodules can be treated by resting the voice, voice therapy, water-aerosol inhalation, electrical stimulation therapy, minor surgery.

In some cases, doctors also prescribe inhalations to moisten the laryngeal mucosa or electro-therapy (TENS). Vocal cord nodules are scarcely treated with medication.

If the nodules do not disappear with rest and treatment, they can be removed during a minor surgical intervention. The common risks associated with surgery and anesthesia apply to such operations. In rare cases, the operation may also cause scarring that permanently changes the sound of the voice.

What is everyday life with vocal cord nodules like?

For people who have to talk frequently and loudly because of their job, vocal cord nodules can be debilitating. If vocal dysfunction occurs repeatedly, it is important to find opportunities to rest the voice. For example, it might sometimes be better to split speaking-related tasks with colleagues.

Those who are forced to speak loudly due to noise can ask the employer to provide a quieter environment or to provide technical solutions such as microphones and loudspeakers. With measures like these and voice therapy, many people can keep their voice problems in check. In any case, vocal dysfunctions should be taken seriously to prevent frequent sick notes or even a change of job.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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