Vocal cord nodules are small, benign, callus-like growths on both vocal folds caused by repeated voice strain. They are common in singers, teachers and children who shout, and make the voice rough and quick to tire.
Key symptoms
- Hoarse, breathy or rough voice
- Voice fatigue that worsens through the day
- Loss of vocal range, especially high notes in singers
- Throat discomfort or frequent throat clearing
What you find on exam
- Listen to voice quality and breathing
- Head and neck exam, including lymph nodes and thyroid
- No stridor or neck mass
Tests
- Laryngoscopy for hoarseness lasting over 4 weeks, or sooner if concerning
- Videostroboscopy: matching nodules where the front and middle thirds of the folds meet
- Biopsy only if the lesion looks atypical
Treatment basics
- Voice therapy with a speech-language pathologist as first-line treatment
- Voice rest, good hydration, no shouting or whispering
- Treat reflux and allergies when present; stop smoking
- Microsurgery only for nodules that persist after voice therapy
Red flags
- Hoarseness over 4 weeks in a smoker or heavy drinker
- Stridor, trouble swallowing or coughing blood
- Neck mass or weight loss
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.