Definition

Your vocal cords are V-shaped folds of tissue located in the throat that vibrate when you talk, sing, or shout. Air from the lungs passes through your vocal cords, causing them to vibrate and produce sound. In the case of vocal cord nodules, benign (noncancerous) tissue growths or lumps appear on the vocal cords. These benign growths can be nodules, polyps, or cysts, which can lead to hoarseness.

Vocal cord nodules can occur in people of all ages and genders. This condition is commonly associated with frequent voice use, such as in singers, public speakers, and teachers. In addition to overuse, nodules or lumps on the vocal cords can also result from vocal cord trauma.

Causes

Vocal cord nodules are typically caused by overuse of the vocal cords, such as talking or shouting too much. This overuse can lead to prolonged vibration and friction of the vocal cords, resulting in inflammation and the formation of lumps. Other conditions, like gastroesophageal reflux disease (GERD), can also cause inflammation of the vocal cords and exacerbate symptoms.

Risk Factor

Risk factors for vocal cord nodules include excessive use of the vocal cords, often seen in singers, public speakers, coaches, street vendors, teachers, preachers, and others. Additional factors contributing to vocal cord nodules include smoking, frequent alcohol consumption, allergies, sinusitis, side effects of certain medications, and hypothyroidism.

Symptoms

Symptoms of vocal cord nodules are relatively easy to recognize and include:

• Hoarseness or a lower pitch than usual
• Pain in the neck area
• Ear pain, especially when speaking
• Coughing
• A feeling of something stuck in the throat
• Fatigue or weakness

Diagnosis

Your doctor will ask detailed questions about your voice disorder and perform a physical examination to diagnose the condition. During the physical exam, your doctor will use a topical anesthetic, which numbs the surface tissues, applied before examining your vocal cords with mirrors, a flexible laryngoscope, a rigid laryngoscope, or a videostroboscope.

• Mirror. A long, stiff instrument with an angled mirror is inserted into your mouth, similar to a dental mirror.
• Flexible laryngoscope. A flexible tube with a light and camera at the end is inserted through your nose to view your vocal cords.
• Rigid laryngoscope. A rigid tube with a light and camera at the end is inserted through your mouth to view your vocal cords.
• Videostroboscope. A camera combined with a light is inserted into your mouth to provide a slow-motion view of your vocal cords in action.

Additional tests for vocal cord nodules may include:

• Sound (acoustic) analysis. Using computer analysis to assess irregularities in the voice produced by the vocal cords.
• Laryngeal electromyography. Inserting a small needle through the skin to measure electrical currents generated by your vocal cords.

Management

Based on the diagnosis, your doctor may recommend several treatments, such as:

• Rest, adequate fluids, and voice therapy. Your doctor will suggest resting and minimizing talking to limit vocal cord use. Adequate fluid intake is also recommended.
• Allergy therapy. If allergies are causing mucus buildup in the throat, your doctor will identify the allergens and provide appropriate treatment.
• Quitting smoking. If you smoke, your doctor will advise you to stop, as cigarette smoke irritates the respiratory tract, including the vocal cords. Quitting smoking can improve your voice and overall health and reduce cancer risk.
• Medications. Prescribed based on the cause of the voice disorder, such as reducing inflammation, treating GERD, etc. Medications can be oral, injected into the vocal cords, or applied topically during surgery.

If voice disorders are due to medication side effects, discuss this with your doctor, especially if symptoms persist after taking specific medications. Surgery may be considered if there is no improvement after several days.

Complications

Complications usually arise from surgical procedures to treat vocal cord nodules. The most common complications include numbness of the tongue, altered taste sensation, and minor trauma to the teeth, mouth, and pharynx due to the use of laryngoscopes during surgery.

Other risks related to surgical treatment of vocal cord nodules include potential changes in voice quality, bleeding, infection, and injury to the oropharynx, as well as scar tissue formation during post-operative recovery. These potential complications must be weighed against the benefits of surgery for the patient.

Prevention

Preventive measures for vocal cord issues include avoiding excessive use of the vocal cords, avoiding cigarette smoke, limiting alcohol and caffeine intake, staying hydrated, getting enough sleep at night, using a humidifier, warming up before prolonged talking or singing, resting your voice, avoiding excessive talking or singing during upper respiratory infections, maintaining good hygiene, and avoiding foods that can cause irritation, such as oily foods (fried foods).

When to See a Doctor?

The most common symptom of vocal cord issues is a change in voice, such as hoarseness or a lower pitch that sounds unusual. Consult a doctor if you experience these symptoms or if they are accompanied by fever, cough, neck pain, or painful swallowing that persists for several days without improvement.