Vocal nodules are callous-like bumps that form on the vocal cords. They usually occur on both cords rather than on just one side. The primary cause of vocal nodules appears to be prolonged vocal abuse and misuse that can include any of the following:

  • Excessive shouting, screaming, or yelling. 
  • Excessive throat clearing or coughing. 
  • Talking over long distances such as the playground or on the field in sports. 
  • Talking in noisy places. 
  • Talking too loudly on a consistent basis. 
  • Speaking during strenuous physical exercise. 
  • Use of strained vocalizations such as the sounds used to imitate motors or animal noises. 
  • Talking on insufficient breath or holding breath while speaking. 
  • Amateur singing. 
  • Use of inappropriate pitch - either too high or too low. 
  • Chronic upper respiratory infections or allergies.

Some of the voice characteristics that may be present are husky or hoarse voice quality, low pitch, frequent throat clearing due to the sensation that something is in the throat and a voice that fatigues or tires easily with speaking. In addition, the voice may be clearer in the morning and more hoarse or "raspy" later in the day. Tension in the throat area may be present, as the child must use excess effort to get his voice out. This may be seen in muscles that cord or bulge out in the neck.

The treatment for vocal nodules usually is voice therapy and a home program. The primary goal of therapy initially is to eliminate the vocally abusive behaviors and teach the child how to use his voice efficiently. It is important that all people in the child's environment be involved in this goal (including family members, friends, teachers, coaches, etc.) so that vocal abuses can be eliminated in all settings and rules about voice use can be enforced consistently. Some examples of rules that may be set include:

No screaming, yelling, or shouting is allowed.

Motor or animal sounds are not allowed.

No talking over long distances. You must go to the person to whom you need to speak. On the playground or ball field, hand signals may be devised.

Volume must be appropriate at all times - not too loud, but not whispering, either.

Habitual or chronic throat clearing is not allowed. Try swallowing or drinking water instead.

Amateur singing should be discouraged.

No talking over a loud television, CD player, record player, or radio.

Once these abusive behaviors are under control, the vocal nodules may disappear and other issues may be resolved. Pitch may become more normal once the added mass is no longer present, and tension may be eliminated once the child no longer has to strain to get a voice out. If pitch, breathing, respiration, or tension continue to contribute to the vocal misuse, these factors will be addressed in therapy as well.

It is important that you as a parent set a good example in the way that you use your voice. Also, take this as an opportunity to get all children in the family involved in use of good vocal habits. Your involvement, along with the otolaryngologist and speech-language pathologist, will ensure your child's success in remediating the problem of vocal cord nodules.

References: Boone, Daniel R, The Voice and Voice Therapy, Ed.2, Prentice-Hall, Inc. 1977Developed by Robin Morlier, MS, CCC-SLP Speech-Language PathologistCopyright 1998, Children's Health System Check Center, CK Info 39, 2M, 6/98