Description and Cause

Vocal nodules are the most common benign pathology and are typically caused from phonotraumatic behaviors. These behaviors are typically associated with talking too much, too loud or over noise.   Vocal nodules are inflammatory degeneration of the superficial layer of the lamina propria, which is the second layer of the vocal folds. Nodules have been described as ‘blister-like formations’  that typically form on both vocal folds.  Nodules are typically caused by mechanical trauma or ‘high impact stress’ during voicing.  This could be from producing a loud or harsh voice for extended periods of time.  Acute (or newly formed ) nodules will appear soft and pliable and chronic nodules will appear firm, callous-like and fixed to the underlying mucosa of the vocal folds. 

Signs and Symptoms

  • Voice quality varies from early to mature formation
  • Raspy
  • Hoarse
  • Breathy
  • Easily fatigues
  • Singers often experience:
    • Loss of vocal range 
    • Loss of vocal endurance
  • Increased breath flow
  • Increased breathing effort
  • Overly tense vocal folds
  • Asymmetric vocal fold vibration

Visual Assessment

  • Increased mass and stiffness
  • Possible hourglass closure pattern of the vocal folds
  • Decreased vibratory characteristics of the vocal folds
  • Tension from above the vocal folds might be present


  • Vocal hygiene therapy 
  • Behavioral voice therapy
  • Medical - eliminate other causative factors (i.e. allergy, frequent URI’s, LPR etc.)
  • Surgery - Not often necessary