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What are vocal cord nodules?

Vocal cords are two small muscles located in the larynx (voice box) that are responsible for voice production. Nodules are small, non-cancerous, callous-like growths that usually form in pairs, one on each vocal cord. They form at the first point of contact when your vocal cords come together to vibrate.  This is usually in the front section of each vocal cord.

Figure of two vocal cords, the first illustrates normal vocal cords in an open position with straight edges, the second illustrates where the nodules are located.

During normal speech, the vocal cords open and close. Nodules mean the cords cannot close completely and this will allow extra air to escape. This makes the voice sound hoarse and breathy. The voice may lower in pitch, get quieter and become easily strained or tired.

Figure of two vocal cords, the first illustrates the normal closure of cords and the second illustrates the gap caused by nodules where air can leak through.

Images courtesy of Lucian Sulica, MD, www.voicemedicine.com

What causes vocal cord nodules?

The following factors can contribute to vocal cord nodules.

Misuse of your voice:

  • Talking too high or too low. Talking too loudly or with a different quality can strain the voice.
  • Not enough breath support may cause you to talk to the end of your breath and push your voice.
  • Too much tension in the neck muscles when speaking can cause increased strain.
  • Shouting, screaming, cheering or yelling makes the vocal cords bang together forcefully.
  • Too much coughing or throat clearing makes the vocal cords bang together forcefully.

Other causes:

  • Heavy vocal load – prolonged periods of voice use such as singing or speaking at loud volumes or against background noise.
  • Chronic chest or throat infections and allergies.
  • Smoking or being around smoke dries your vocal cords and strains your voice.
  • Reflux – stomach acid coming up the oesophagus (food pipe) and into voice box.

Do vocal cord nodules hurt?

There is unlikely to be any pain. The most common symptom of nodules is the breathy and hoarse quality of your voice. Tell your doctor if you have pain.

How can Speech Pathology help?

Speech Pathology helps identify and reduce the causes of nodules. It teaches you better ways of using your voice. Reducing or removing nodules can take time, depending on how developed they are. Vocal cord nodules are unlikely to go away without changing your voice habits.

If nodules become fibrosed (hardened) they may need surgery.

Why is surgical removal alone not usually recommended?

Unless the causes of vocal cord nodules are reduced or changed, the nodules will most likely come back even if they are surgically removed. A trial of voice therapy is recommended before offering surgery.

How you can help

  • Talk less and avoid talking over background noise.
  • Avoid situations which might strain your voice, for example in large groups, noisy environments or when you are outdoors.
  • Do not attempt to ‘push your voice out’ as this will bang the vocal cords together.
  • Reduce shouting, screaming, yelling, coughing, clearing your throat, crying, laughing very loudly or grunting. Swallow or sip water if you need to cough or clear your throat.
  • Avoid whispering as this often places strain on your vocal cords.
  • Sip water often.
  • Inhale steam daily. Put your face near a bowl of hot water, put a tea-towel over your head to catch the steam and breathe for five minutes.

Disclaimer This document describes the generally accepted practice at the time of publication only. It is only a summary of clinical knowledge regarding this area. The Royal Victorian Eye and Ear Hospital makes no warranty, express or implied, that the information contained in this document is comprehensive. They accept no responsibility for any consequence arising from inappropriate application of this information.

  • Vocal Cord Nodules #61
  • Owner: Speech Pathology
  • Last Reviewed: February 10, 2020
  • Next Review: February 10, 2023