Vocal cord nodules Dr Vivek Baliga

Vocal Nodules – Causes, Treatment And Prevention

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Has your voice suddenly started to become hoarse? You may have vocal nodules.

Vocal nodules can form if you use your voice too much for a long time. They are also called vocal fold nodules or vocal cord nodules. They make your voice sound different and make it hoarse.

What Are Vocal Cords?

There are two folds of membrane tissue that make up the vocal cords. They are about in the middle of the larynx, which is the start of your breathing system.

It is also called the voice box.

The edges of the vocal cords are attached to small muscles that help move them. Your vocal cords move closer together when you speak or sing. As air moves through them, they vibrate and make sounds. Each person has a unique way of their vocal cords moving. This is why we all have different voices.

What Are Vocal Nodules?

If you use your vocal cords too much, the membrane tissue can get swollen and small bumps can form. These are vocal nodules.

There are also other things that can make your voice act up. Most of the time, it’s because the larynx is inflamed (laryngitis).

Voice problems can also happen if you smoke or if your vocal cords become stiff. In very rare cases, they are caused by a cancerous tumour or mental illness.

Symptoms Of Vocal Nodules

Most of the time, vocal nodules make your voice hoarse and sound clearly different.

People who enjoy singing may fine that with vocal nodules they can’t hold a note as long as they used to be able to.

Reaching high pitched sounds or even keeping low notes can be hard.


When you use your voice too much, the membranes that cover your vocal cords and the tissue below them can swell up.

Due to this swelling, your vocal cords don’t fit together correctly. This makes them vibrate in a different way that changes the sound of your voice. This also makes it hard to make certain sounds.

Your voice gets hoarse or (in worst cases) you can lose it completely. Overuse of your voice can happen if you talk too much or too loud.

Voice problems can also be made more likely by bad posture. People who use their voice a lot at work are more likely to get vocal nodules. One example is people who sing for a living (this is why they are also called Singer’s nodules). Using the wrong way to sing can also make the risk higher.

They are also more common among teachers (so they are also called teacher’s nodules). Not only do they have to talk a lot, but they often have to raise their voices to be heard.

If a baby or toddler cries or screams a lot, they may overuse their vocal cords, which can cause nodules.

How Common Is It?

Women and children are more likely to get vocal nodules than men. They are some of the most common reasons why kids get a hoarse voice.

As mentioned earlier, if you use your voice too much, the edges of both vocal cords will swell up at first. This is especially true between the front and middle thirds. These are the most important parts of the vocal cords.

At this point, people will already be having trouble with their voices. If they keep using their voice too much, nodules will form on the edges of the swollen vocal cords. These are the size of tiny peanuts.

Most of the time, vocal nodules don’t cause any serious problems. However, they are a nuisance as a person’s voice is their identity, and this messes with that.

Symptoms Of Vocal Nodules

Typical symptoms include a hoarse voice that lasts for a long time, a change in the way the voice sounds, and more effort needed to speak.

Diagnosis Of Vocal Nodules

To find out if the problems are caused by vocal nodules, a specialist, like an ENT (ear, nose, and throat) doctor, needs to look at the vocal cords. An endoscope, which looks like a flexible or rigid tube, is used to do this test, which is called a laryngoscopy (or laryngoscope). A local anaesthetic is sometimes used to numb the mucous membranes.

A special device that magnifies the vocal cords can also be used to measure how easily the vocal cords move. This thing, which is called a stroboscope, has a light on it that flashes very quickly. The flashing light makes it look like the vocal cords are moving slowly, so you can get a better look at them.

Treatment Of Vocal Nodules

The most important thing is to give your voice as much rest as you can.

For example, people who talk on the phone a lot could consider texting or using email.

Adults and older children can also get voice therapy, such as from a speech therapist, in addition to resting their voices. This means learning to time your speech and breathing together, as well as learning to relax and improve your posture.

Steroid injection into the vocal nodules has also been shown to be effective in clinical studies.

Treatments for vocal cord nodules include voice therapy and learning how to use your voice correctly, which is also known as practising good vocal hygiene. For good vocal hygiene, you should:

  1. Trying not to yell or scream
  2. Getting a lot of water
  3. Eating well is important.
  4. Acidity can sometimes lead to vocal cord issues. Treating acid reflux can help.
  5. Steam inhalation is also a helpful treatment.

If they don’t go away after resting your voice and trying the above treatments, you may be offered minor surgery to get rid of them.

Surgery For Vocal Nodules

If non-surgical treatments don’t help relieve hoarseness or inflammation of the vocal cords, your doctor may suggest one of two surgical procedures to remove the nodule.

Laser Surgery

Laser surgery is a quick, safe, and effective way to treat the majority of people who need to get rid of benign vocal cord nodules. Based on your medical history and the results of a physical exam and voice evaluation, an ENT surgeon can decide if you are a good candidate for this procedure. Laser surgery can take care of a lot of small lesions on the vocal cords.

Laser surgery is done in the hospital, and it can often be done right after a diagnosis.

In this procedure, the doctor sprays an anaesthetic on your throat to numb your vocal cords. Then, he or she puts a scope down your nose and into your throat. Laser beams with very high energy are used to get rid of the lesion. The laser is built into the tip of the scope.

This procedure doesn’t take long, and most patients have reported minimum discomfort. Because the laser can be used with great accuracy and is made to remove the lesion without causing bleeding, there is a low chance that it will come back or cause other problems.

Excision With Microlaryngoscopy

If a lesion on your vocal cords is big or in a place that is hard for your doctor to reach, they may use a procedure called micro-laryngoscopy to remove the nodule. This usually takes between 30 and 60 minutes and is done in the operating room under general anaesthesia.

During a micro-laryngoscopy, your doctor uses equipment called a laryngoscope to look at your vocal cords through your mouth. This tool gives you high-quality images that can be enlarged to show every detail of your vocal cords and the areas around them. The lesion is then removed by the surgeon with tiny surgical tools. You won’t need stitches, and you should be able to go home the same or the next day.

Complications Of Surgery

During laryngoscopy, the most common problems are a numb tongue, a change in taste, and small injuries to the teeth, mouth, and pharynx.

Other risks include the chances that the patient’s voice will get worse, that they will bleed, get an infection, hurt their teeth, or hurt their oropharynx (throat), and, most importantly, that they will get scars because they cut too much tissue or because of how they heal.

Vocal cord function gets better over time after surgery. Voice therapy is a key part of getting better. Most ENT surgeons will advise seeing a speech therapist after treatment has concluded. This helps the patient restore as close to their normal voice as possible.

Dr Vivek Baliga B
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