Vocal cord nodules (referred to as “vocal fold” nodules by physicians) are growths that form on the vocal cords. These bumps are benign (noncancerous) and are similar to calluses that can form on the hands.
Nodules affect girls and boys of any age, and are a common cause of voice issues in both children and adults.
Vocal cord nodules are also called “Singer’s nodules,” as people who use their voice regularly may inadvertently ‘abuse’ their vocal cords and cause the formation of these growths and related voice issues.
The most common symptom of vocal cord nodules is a raspy or hoarse voice. You may also hear straining and pitch breaks in your child’s voice when he talks or sings.
Vocal cord nodules usually develop due to chronic abuse of the voice over time, such as straining, yelling and frequent singing. Ongoing friction between the vocal cords creates callous-like growths.
Gastroesophageal reflux disease (GERD) can cause additional swelling and inflammation, worsening symptoms of vocal cord nodules.
Vocal cord nodules can be diagnosed using the following procedures:
- Laryngoscopy: A doctor will place a spaghetti-like camera in your child’s nose and down the throat. This allows our team to look at your child’s voice box, or larynx.
- Stroboscopy: A small, thin, flexible endoscope with a camera is gently inserted through the nose to the area in the back of the throat above the vocal cords. The study evaluates the motion and vibration of your child’s vocal cords when there are concerns regarding the strength, pitch and quality of his voice.
Most of the time, these exams can be done while your child is awake and in an office setting.
The recommended treatment of vocal cord nodules includes learning to properly use the voice (also known as practicing vocal hygiene) and voice therapy. Practicing good vocal hygiene includes:
- Avoiding yelling/screaming
- Learning to properly imitate when pretend-playing
- Drinking plenty of water
- Maintaining a healthy diet
- Managing symptoms of reflux and allergies: Many times, the swelling of the vocal folds that lead to nodules are triggered by regurgitation, so reflux management may be recommended
At CHOP’s Pediatric Voice Program, voice therapy is performed by a speech pathologist who is trained in voice therapy for children.
The prognosis for children and adolescents with vocal cord nodules is good. With proper vocal hygiene, reflux management when needed, and voice therapy, a majority of patients have a significant improvement in the voice and many have resolution of the voice problems.
Children with persistent nodules and symptoms of voice problems may require more aggressive therapy if the impact on the voice is severe. Children are not likely to need surgery to treat nodules, though professional voice users (i.e. singers and actors) do sometimes need surgery to remove vocal cord nodules if it affects their livelihood.
If voice therapy is recommended, the initial follow-up will be about three months after beginning therapy in order to assess progress and response.
If reflux medications or dietary modifications are recommended, then a follow-up in the clinic will likely be suggested as well. If the voice responds to this form of treatment, then no further follow-up is needed. If the voice is still problematic, then your child may need to be seen every six to 12 months to monitor her voice.
Our voice team at The Children’s Hospital of Philadelphia is a dynamic multidisciplinary group of professionals with years of experience managing pediatric voice difficulties.