Vocal Fold Nodules

Vocal fold nodules are bumps on the vocal folds (also called vocal cords). They are like calluses that you may get on your hands when using a shovel. The bumps disrupt the way the vocal folds vibrate when your child speaks causing a hoarse or raspy voice.

Sound is produced when the vocal folds are brought together and air from the lungs is forced through the space between them. This causes the vocal folds to vibrate, making sound. When your child makes certain sounds, the vocal folds can slap against each other. This can injure the vocal folds and cause calluses to form.

Children can injure their vocal folds by:

• Loud yelling
• Making growling noises (like imitating animals or vehicles)
• Frequent throat clearing or forceful coughing

Vocal fold nodules do not cause cancer, and they are not a sign of more serious illness. They may affect your child’s self-image and limit how they communicate with others or take part in activities.

When your child stops using their voice in ways that stress their vocal folds, the nodules usually go away. This almost always happens naturally over time. This may not happen until your child is a teenager. A voice therapist can help figure out what might be causing injury to your child’s vocal folds. Your child may be more at risk for getting vocal fold nodules when they are irritated from things like a cold, allergies, or smoke.

A voice-trained speech-language pathologist (SLP) can identify any patterns or habits that may be contributing to your child’s hoarseness. If your child is determined to be a good candidate for voice therapy, the SLP will recommend a short period of voice therapy to improve your child’s vocal quality.

Through voice therapy, we can often get the nodules to shrink or go away over many months by helping your child use their voice better. This involves using behavior modification to teach your child to:

• Avoid yelling, screaming, loud talking, singing or making growling noises
• Avoid whispering
• Reduce throat clearing and coughing. You can teach your child to take a sip of water instead.

Most children notice voice improvement in the first few months. They may talk better, participate in activities more and have a better self-image. Having a completely clear voice is often hard as vocal habits are hard to break. The more your child practices these exercises at home, the more they will benefit from voice therapy.

We can surgically remove nodules, but we rarely recommend this for children. First, nodules often come back if your child has not changed their habits. Second, in rare cases the surgery may produce scarring on the vocal folds that can produce permanent hoarseness.

We often recommend a follow-up evaluation at around 1 year if the hoarseness is not getting worse. We will want to see your child more frequently if you choose voice therapy with one of our speech-language pathologists. We may want to see your child sooner if the diagnosis of nodules is less certain, if your child is having severe or progressive voice problems, or if you just need support in your efforts to help your child improve their voice.