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Voice Disorders and Therapy

What are vocal cord nodules? Do they require surgical removal? Will they return post
voice therapy? Are they malignant?

Simply put vocal cord nodules are benign (non-cancerous) “pimples” or lesions which
grow on the anterior portion of the vocal cords (typically the front 2/3 of the vocal cords) and
will generally lend to a hoarse/breathy voice. They develop from friction between the vocal
cords and or tension. The nodules may be caused by screaming, speaking with much tension,
excessive strain, etc… To properly understand why the nodules cause a breathy voice, think of
an hourglass shape; it is wide on top then narrows in the middle and once again becomes wide
on bottom. The same shape occurs when nodules are present. That is, because the nodules
protrude when the vocal cords try to close, the front and back of the vocal cords remain
partially open and only the nodules which are sticking out will indeed close fully. The air
subsequently escapes through the front and back and thus will result in a breathy voice.

Vocal cord nodules if left untreated may become hard and fibrotic with time. And while
surgical removal is typically not necessary for vocal cord nodules, those left untreated may
facilitate an increased chance of requiring surgery to restore optimal vocal quality.
Nonetheless, as mentioned, in cases of v.c. nodules, proper vocal training can significantly
reduce the size of the lesions and often eliminate them.

Voice therapy for nodules varies depending on the various contributing factors (age,
severity, external factors, etc…). Nonetheless, often the therapy will entail much focus on
learning to use appropriate resonance as well as some level of concentration on appropriate
breathing, proper vocal hygiene, and vocal warm-ups. This will be discussed in greater detail in
a future article.

Once the therapy has been completed, in my experience treating patients with nodules,
most of the cases did not experience recurrence. As well, even regarding situations where the
lesions did return, typically a brief review of the techniques learned was all that was necessary
rather than having to “start from the beginning”.

As with any health concern, the sooner that the issue is properly identified and
remediated, the more likely the chances are for a successful outcome. As well, it is important to
keep in mind that each case varies and three people with vocal cord nodules may be treated
differently due to the varying contributing factors.

In the next article we will discuss vocal cord polyps and cysts. Stay tuned…

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