Vocal cord nodules appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. These lesions often diminish or disappear when overuse of the area is stopped. If your child has been diagnosed with vocal cord nodules, the first step is to understand their cause and treatment. Parents, siblings, teachers, and even the child’s friends play an important part in the elimination of the causes of the nodules. It is hoped that this information will clarify the nature and treatment of vocal cord nodules and the role that you play in the treatment process.
How the Voice Is Produced
The voice is produced in the larynx, or voice box, which is located in the neck behind the Adam’s apple. The voice itself is produced by the vibration of the vocal cords, which are located in the larynx. During phonation (or production of the voice), the vocal cords close and are vibrated by air coming from the lungs. This should be an easy, effortless process.
How Vocal Cord Nodules Develop
Vocal cord nodules develop as a result of abuse to the vocal cords. They are callous-like bumps on the vocal cords. They usually form on both cords, but are occasionally seen on just one side. If vocal cord nodules are present, then the vocal cords cannot close completely. This results in air escape, making the voice sound breathy and hoarse.
The Causes of Vocal Cord Nodules
Vocal cord nodules are caused by misuse or abuse of the voice and therefore the vocal cords. Vocal misuse can include;
- Use of an incorrect pitch or volume.
- Poor breath support for speaking or singing.
- Controlling the voice at the level of the larynx (voicebox).
The most common cause of vocal cord nodules in children is vocal abuse. Vocal abuse includes:
- Excessive shouting, screaming, whining, cheering, crying, etc.
- Strained vocalization, such as imitation of motor sounds.
- Animal noises, superhero sounds, etc.
- Excessive talking.
- Excessive coughing and/or throat clearing.
Other factors that may be associated with the development of nodules include:
- Chronic upper respiratory infection or allergies.
- Smoking and second-hand smoke exposure.
- Air pollution
One or a combination of the above factors may cause the formation of vocal nodules.
Vocal abuse can cause the vocal cords to close with excessive force (ie. bang together). As this happens, a slight reddening is noted on the edge of the vocal cord. This is followed by swelling or thickening along the edge of the cord. Finally, a definite bump or nodule develops on the front one third of the vocal cord, where the point of maximum vibration occurs. Nodules can range in size from a small as a pin head to as large as a split pea. The primary symptom of vocal cord nodules is a breathy and hoarse voice.
Treatment for Vocal Cord Nodules
The purpose of voice therapy is to identify vocal abuse, eliminate vocal abuse, and teach the child effective use of the voice. The elimination of the vocal abuse, which first caused the vocal cord nodules, must be the basis of any program to eliminate the vocal cord nodules. It must be remembered that most nodules form over a long period of chronic vocal abuse. Just as the nodules did not appear overnight, they will also not disappear overnight. The elimination of the abuse needs to be over a larger period of time. Elimination of the abuse for only a week or two will not be effective.