Vocal fold nodule

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Vocal voice nodule
Classification and external resources
Specialty pulmonology
ICD-10 J38.2
ICD-9-CM 478.5
DiseasesDB 29628

A vocal fold nodule is a mass of tissue that grows on a vocal fold. Typically this mass appears on the junction of the anterior 1/3 and posterior 2/3 of the vocal fold, where contact is most forceful.

A vocal fold nodule reduces the ability of the vocal folds to create the rapid changes in air pressure which generate human speech. Symptoms include hoarseness , painful speech production, frequent vocal breaks, and reduced vocal range. Vocal fold nodules develop mostly in adult women and in children of both sexes.[1]

The nodules appear as symmetrical swellings on both vocal cords. The cause of these formations is usually strenuous or abusive voice practices such as yelling, poor singing techniques, and coughing. Those who use their voices constantly in a loud environment are susceptible.


Grossly: these inflammatory polyps are smooth, hemispheric protrusions (less than 0.5 cm in diameter), located most often of the true vocal cords and are usually bilateral.

Microscopically: they are composed of fibrous tissue core covered by stratified squamous epithelium, and sometimes the mucosa may ulcerate.


Vocal fold nodules can certainly impair one's speaking and singing ability. They rarely harm one's general health. However, the psychological trauma of being diagnosed with nodules—a trauma affecting those especially whose professional success depends on consistently using a rich and powerful vocal tone (e.g. singers, actors, broadcasters)—typically dwarfs the limited systemic and even otolaryngological effects.


Histopathologic image of vocal fold nodule or polyp. Biopsy specimen. H & E stain.

Treatment, or voice rehabilitation, usually involves vocal training, voice therapy, and, occasionally, vocal rest. Rehabilitation with a speech-language pathologist is essential. In rare cases, surgery may be required. Removal of vocal fold nodules is a relatively safe and minor surgery. However, those who sing professionally or otherwise should take serious consideration before having surgery as it can affect the ability to sustain notes, as well as alter the vocal range. Examples of this are Julie Andrews, Ryan Key, and José José, who lost much of their singing ability after undergoing vocal nodule surgery. However, a lot of the time the surgery is very successful and leads to a full recovery of the voice, as with the Icelandic singer Björk. While the patient is subdued under general anesthesia, long thin scissors and scalpels are used to remove the nodules, or CO2 surgical lasers might be used which are very effective in such cases.

Symptoms of vocal fold nodules include vocal fatigue and hoarseness or breathiness. Hoarseness or breathiness that lasts for more than two weeks may signal a voice disorder and should be followed up with an otolaryngologist.

See also[edit]


  1. ^ Blake Simpson, Clark Rosen, Hans Von Leden, Robert H. Ossoff (2008) Operative Techniques in Laryngology

External links[edit]