What are vocal fold nodules and should you be worried?

Vocal nodules are one of the most talked about voice disorders among singers, teachers, and other occupational voice users. The term alone can spark fear, but the good news? Nodules are treatable, and in many cases, reversible without surgery.

So, What Exactly Are Vocal Nodules?

Vocal nodules are benign (non-cancerous), callous-like growths that form on the vibrating edges of the vocal folds. They’re typically bilateral (meaning they appear on both sides) and form in the area where the folds meet most forcefully during phonation (voice production). These growths interfere with the normal, smooth vibration of the vocal folds, which results in noticeable changes to voice quality. You can think of them as your vocal folds’ version of calluses from overuse.

What Causes Vocal Nodules?

The primary cause of nodules is chronic vocal strain or misuse, for example, shouting, over-singing, speaking for long periods without rest, or using vocal technique not conducive to your needs. However, vocal misuse is often just one piece of the puzzle.

Other contributing factors include:

• Poor vocal hygiene (e.g., dehydration, excessive throat clearing)

• Allergies and reflux (which irritate the vocal tract)

• Stress or emotional tension (which can affect how we use our voice)

• Unaddressed respiratory issues or sinus congestion

• Hormonal factors (especially for females)

Who Is Most at Risk?

While anyone can develop nodules, they’re especially common in people with high vocal demands.

This includes:

• Singers and actors

• Teachers and lecturers

• Call centre and telecommunication workers

• Coaches, fitness instructors, and group leaders

• Children, who often yell or scream during play

Women are statistically more likely to develop nodules, likely due to the anatomy and vibratory patterns of female vocal folds.

Signs and Symptoms to Watch For

If you’re noticing your voice isn’t bouncing back the way it used to after a big gig, workshop, or a long teaching day, you might be experiencing early signs of nodules.

Common symptoms include:

• Persistent hoarseness or a raspy voice

• Breathiness or a voice that cuts out

• A scratchy or rough quality

• Difficulty reaching high notes or vocal fatigue after speaking or singing

• A sense of strain, tightness, or effort when using your voice

Sometimes, nodules may also cause voice breaks, loss of vocal range, or the need to push harder to make sound.

What Should You Do If You Suspect Nodules?

Don’t panic and don’t delay. Early intervention is key to a full, non-surgical recovery.

Here’s what you should do:

1. See a laryngologist (ENT who specialises in voice disorders) for a stroboscopic exam. This allows for visualisation of the vocal folds in motion.

2. If nodules are confirmed, you’ll likely be referred to a voice-specialised speech pathologist for therapy.

3. In voice therapy, you’ll learn to:

   • Identify and change harmful vocal behaviours

   • Improve breath support, resonance, and vocal technique

   • Adopt healthy vocal hygiene habits

   • Reduce vocal fold collision to allow nodules to resolve

     
     

In many cases, nodules shrink or disappear entirely with consistent therapy and lifestyle changes.

Final Thoughts

Getting nodules doesn’t mean your vocal career is over. In fact, many professional voice users recover stronger than before. What’s crucial is recognising the signs early and taking action to protect your instrument.

If you’re a high-demand voice user, regular vocal check-ups and working with a voice coach or speech pathologist can help you stay on track and keep your voice healthy for the long haul.

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