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Vocal Nodules: Basic Information

Vocal cord nodules appear on both sides of the vocal cords, typically at the midpoint, an directly face each other.  These lesions often diminish or disappear when overuse of the area is stopped.  If your child has been diagnosed with vocal cord nodules, the first step is to understand their cause and treatment.  Parents, siblings, teachers, and even the child’s friends play an important part in the elimination of the causes of the nodules.  It is hoped that this information will clarify the nature and treatment of vocal cord nodules and the role that you play in the treatment process.

How the voice is produced

The voice is produced in the larynx, or voice box, which is located in the neck behind the Adam’s apple.  The voice itself is produced by the vibration of the vocal cords, which are located in the larynx.  During phonation (or production of the voice), the vocal cords close and are vibrated by air coming from the lungs.  This should be an easy, effortless process.

How vocal cord nodules develop

Vocal cord nodules develop as a result of abuse to the vocal cords.  They are callous-like bumps on the vocal cords.  They usually form on both cords, but are occasionally seen on just one side.  If vocal cord nodules are present, then the vocal cords cannot close completely.  This results in air escape, making the voice sound breathy and hoarse.

The causes of vocal cord nodules

Vocal cord nodules are caused by misuse or abuse of the voice and therefore the vocal cords.  Vocal misuse can include;

  • Use of an incorrect pitch or volume.
  • Poor breath support for speaking or singing.
  • Controlling the voice at the level of the larynx (voicebox).

The most common cause of vocal cord nodules in children is vocal abuse.  Vocal abuse includes:

  • Excessive shouting, screaming, whining, cheering, crying, etc.
  • Strained vocalization, such as imitation of motor sounds.
  • Animal noises, super hero sounds, etc.
  • Excessive talking.
  • Excessive coughing and/or throat clearing.

Other factors that may be associated with the development of nodules include:

  • Chronic upper respiratory infection or allergies.
  • Smoking and second-hand smoke exposure.
  • Air pollution

One or a combination of the above factors may cause the formation of vocal nodules.

Vocal abuse can cause the vocal cords to close with excessive force (ie. bang together).  As this happens, a slight reddening is noted on the edge of the vocal cord.  This is followed by swelling or thickening along the edge of the cord.  Finally, a definite bump or nodule develops on the front one third of the vocal cord, where the point of maximum vibration occurs.  Nodules can range in size from a small as a pin head to as large as a split pea.  The primary symptom of vocal cord nodules is a breathy and hoarse voice.

Treatment for vocal cord nodules

The purpose of voice therapy is to identify vocal abuse, eliminate vocal abuse, and teach the child effective use of the voice.  The elimination of the vocal abuse, which first caused the vocal cord nodules, must be the basis of any program to eliminate the vocal cord nodules.  It must be remembered that most nodules form over a long period of chronic vocal abuse.  Just as the nodules did not appear overnight, they will also not disappear overnight.  The elimination of the abuse needs to be over a larger period of time.  Elimination of the abuse for only a week or two will not be effective.

The successful treatment and management of the child with vocal nudules is highly dependent upon the involvement of the parents and the people in the child’s environment.  The first step is to identify the vocal abuses and chart the frequency of the abuse.  Then the child needs to be made aware of these abuses in order to eliminate them.  It is often necessary to establish a new set of rules in which the child uses his/her voice.  These rules might include:

1. No screaming, yelling, or shouting

For example, the child must walk to you before he/she begins to talk, rather than to yell for you in the house.  Remember, if he/she yells for you, do not yell back.  This only reinforces the habit of abuse.

2. No motor, animal, or super hero sounds

Offer him/her other sounds that do not abuse the vocal cords.

3. No loud talking

Loud talking can often be a family problem.  Does the child need to talk over other members in the family to be heard?  Reinforce the rule that only one person in the family can talk at a time.

4. No talking when the television or radio is on

Turn the television or radio off when talking with the child.

5. Throat clearing is not allowed

This can be the result of a habit from when the child had a cold.  Teach the child to use a long, hard swallow which will give the same effect but is not vocally abusive.

6. Singing should be discouraged

Give the child a whistle or musical instrument to play.

7. Drink plenty of water and eliminate drinks with caffeine (ie. dark soft drinks)

Vocal cords which become dry are often more susceptible to injury.  Also, the feeling of dryness often results in throat clearing.

It is very important that these rules be reinforced consistently.  Remember, the vocal nodules did not develop overnight, and likewise, it will take time to eliminate the cause.  Patience and consistency with treatment are essential.  Give your child a lot of positive reinforcement for following the rules.  A sticker chart is often helpful.  Likewise, gentle reminders (rather than nagging) are appropriate when rules are broken.

Just as important is for you and the family to set a good example.  Look at your own vocal habits.  Go to your child when you want to speak to him/her rather than yelling in the house.  Turn the television off when you want to talk.  You can be the most important part of the treatment! Although you cannot do the entire job yourself, your participation and encouragement can mean the difference between success and failure in remediation of vocal cord nodules.