What are Vocal Cord Nodules?

Nodules are when the vocal fold tissue forms hard callouses in response to repeated abuse. They are the most common lesions on the vocal folds. They occur on both vocal folds, are symmetric, and vary in size. Nodules can be chronic or acute, and can cause varied changes in the voice including roughness, breathiness, tension, harshness and pain. Dysphonic vocal quality occurs because the nodules touch when you bring your vocal folds together to make sound, and air escapes from above and below the nodules. This is called diplophonia, or a two-toned sound. Nodules result in an hourglass closure of the vocal folds. They can occur in children and adults and are a result of inappropriate vocal behaviors, excess talking, untrained singing or shouting/screaming often. Nodules usually can be remediated with voice therapy alone. When treatment does not improve, a surgical consultation is usually the next step. It is important to know that voice therapy can be a useful tool in treating these types of lesions because they are like callouses on the vocal folds. With a reduction in poor vocal habits, the callouses will lessen or disappear altogether.

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Listen to an example of a woman with nodules before and after voice intervention. 

What are Vocal Cord Polyps?

Polyps are lesions on the vocal cords filled with fluid. They occur suddenly and grow quickly because they have an active blood supply. Acute vocal fold trauma is usually the cause. Polyps usually occur in adults and are rarely found in children. Polyps can cause various changes in the voice similar to nodules. Some polyps are pedunculated and have a stalk. Surgical removal is usually the option for treatment, however a combination of voice therapy and surgery is best to improve the patient’s vocal habits and use and to decrease the chance of a recurrence. 

Sources: Clinical Voice Pathology: Theory and Management 4th Edition Stemple, Glaze & Klaben

Read and Watch more about Nodules and Polyps:

Actual Patient at a tempo Voice Center Audio Example

Vocal Nodules and Polyps ASHA

Vocal Nodule Video from Dr. Thomas