Vocal fold Nodules are symmetric, non-cancerous growths which occur on both vocal folds. Nodules result from vocal misuse and are mostly seen in young women and pre-adolescent boys. Nodules are always bilateral and appear directly apposing each other. With recurrent vocal misuse, calluses (Nodules) form on the surface of vocal folds due to the continuous impact of vocal folds with each other. As a result, professional and amateur singers are prone to developing Nodules.
The main symptom is painless hoarseness. The presence of Nodules disturbs the normal vibration and closure of the vocal folds resulting in hoarseness. The hoarseness usually worsens with voice use (voice fatigue) and improves with voice rest.
Voice rest often improves the hoarseness due to reduction of surrounding swelling but does not shrink the Nodules. Similarly, anti-inflammatory medications, such as steroids, reduce swelling, but do not address the root of the problem.
Voice therapy is the treatment of choice for these lesions and is highly effective in resolving the majority of Nodules. The goal of voice therapy is to make the patient aware of the type of voice use that has led to the problem, and to find strategies to limit the irritation.
Nodules are a condition that needs to be managed over time. With correct voice use, the Nodules shrink; however repeat vocal misuse often results in recurrence of the Nodules. The less advanced the Nodules, the easier they are to cure.
On rare occasions, patients may need surgery to remove advanced lesions. Surgery is reserved for patients in whom voice therapy has been unsuccessful. Surgery does not, however, preclude voice therapy. If lesions are removed, and the underlying causes are not addressed, the patient is at risk for recurrence of the Nodules.