Vocal fold nodules are symmetrical masses that typically occur bilaterally along the midpoint of the vocal folds. The nodules are not cancerous or precancerous in nature, and the location and bilateral symmetry of nodules indicate that they are the result of trauma and physical stress to the vocal folds.
Who is at Risk of Vocal Fold Nodules?
Vocal fold nodules almost always affect young women and prepubescent boys. This would indicate that laryngeal size may be a contributing factor to nodule formation. The condition is also common among those who sing or perform in musical theater on a professional or amateur basis. This may be due to the particular style of singing or the intensity and frequency of the performances.
What Are the Symptoms of Vocal Fold Nodules?
Although normally painless, vocal fold nodules can cause irregularities in vocal fold vibration and closure, which can cause hoarseness. The condition may improve with voice rest but will quickly worsen after extensive voice use, a cold, or a sore throat.
Diagnosing Vocal Fold Nodules
Not all vocal fold masses are nodules. True nodules always occur in pairs at the same point along the vocal fold and are approximately the same size. A unilateral mass is more likely to be polyp, cyst, or thickening caused by impact damage. Adult males with bilateral vocal fold lesions should undergo a thorough examination and stroboscopy to clarify the diagnosis since such lesions will almost never be nodules.
Nodules appear similar to a mound of tissue protruding from the edge of the vocal fold and can vary in size from person to person. Unlike polyps, which are normally red, nodules are the same color as the surrounding vocal fold tissue. Nodules are relatively stable in terms of size, but they may swell slightly after intense vocal use.
How Are Vocal Fold Nodules Treated?
While voice rest may temporarily shrink the nodules, it is not a permanent fix. Likewise, steroids may provide short-term relief from the swelling, but they do not correct the underlying problem.
The primary treatment for vocal fold nodules is voice therapy. The goal of voice therapy is to modify the vocal habits causing the trauma to the vocal folds. With time, the nodules will eventually become softer and more pliable resulting in improved voice quality. Despite the common misconception that vocal fold nodules can end the career of a performing artist, the condition can be successfully managed with discipline and attention to using good vocal technique.
Since vocal fold nodules are typically the result of behavioral factors, surgery is not normally an effective treatment. In rare cases, microlaryngoscopic surgery may be used to remove some of the hardened tissue caused by the damage. This is usually only considered in cases where voice therapy has been unsuccessful. Before undergoing surgery, patients should carefully weigh their level of disability against the potential for scarring and the amount of improvement that can be expected following the procedure.