What are Vocal Fold Nodules?

Vocal fold or vocal cord nodules are small, non-cancerous growths on your child’s vocal cords. They are often caused by voice abuse. Over time, your child’s repeated misuse of the vocal folds results in soft, swollen spots on each vocal fold. The longer vocal abuse continues, the more likely these spots are to become harder and enlarged, like callouses.

What are Some Common Causes of Vocal Fold Nodules?

  • Too much yelling or loud talking
  • Making funny noises with the voice
  • Talking over loud noises
  • Crying excessively
  • Talking in a pitch that is too low or too high
  • Straining to talk
  • Excessive singing
  • GERD (Gastroesophageal Reflux Disease)
  • Allergies
  • Drinking liquids that contain caffeine (dries out vocal cords)

How are Vocal Fold Nodules Evaluated?

Vocal fold nodules are evaluated by an otolaryngologist using a test called a laryngoscopy. During a laryngoscopy, a flexible tube is inserted through the nose, or a rigid scope through the mouth, to view the vocal cords as they open and close. A stroboscope (flashing light) may also be used to watch the vocal cords as they move. This type of examination can assess for causes of breathing difficulties, voice changes/disorders or feeding/swallowing problems. Although it is not required, it is recommended that a child not eat for approximately 30 minutes prior to this test. There are no restrictions following the completion of this procedure.
Functional voice assessments are also completed by a speech-language pathologist. The voice assessments consist of having the child speak into a microphone and having the caregiver complete a voice rating form. The assessment measures and rates the quality of the child’s voice compared to same age peers.

What is the Treatment for Vocal Fold Nodules?

Speech-language pathologists offer therapy for the treatment of vocal fold nodules. Therapy focuses on teaching good vocal hygiene, stopping vocal abuses such as loudness, treatment to change pitch and breath support for good voicing. Medical problems such as gastroesophageal reflux (GERD), allergies and thyroid conditions may also need to be treated. Children who have these nodules need to stay away from smoke and known allergens as much as possible. Children must also avoid straining their voice by activities such as cheerleading or yelling on the playground.

If your child needs voice therapy, he/she should follow the advice of the therapists. If vocal fold nodules continue to worsen, surgery may be needed to remove the nodule from the vocal fold. If vocal abuse continues after surgery, there is a risk that the nodules will return. When more surgeries are needed, there is a higher risk of permanent damage to the vocal fold.

Be sure to ask your child’s doctor, nurse or therapist if you have any questions.

When Should I be Concerned if My Child has Vocal Fold Nodules?

Vocal fold nodules often affect the quality of the voice. The voice may sound hoarse or harsh, rough, breathy or scratchy. Some children may experience vocal fatigue and the voice may sound worse at the end of the day. Your child may present a decreased pitch range and complain of throat pain.