Credit: Photo by Alisha Vargas

How to Detect and Prevent Vocal Cord Nodules

Vocal cord damage is a problem I encounter a good deal working in the world of speech therapy. Often, children and adults who are perceived to have “normal raspy voices”, may sound this way because their vocal cords have been abused and damaged. After an extended time,  prolonged vocal cord abuse can lead to swollen spots on each vocal cord. These areas can then develop into hard callouses called “nodules”. The longer the vocal cord abuse continues, the larger and more calloused the nodules become.

What causes vocal nodules and how do you know you have them?  

There are many ways you can abuse their voice without even realizing you are doing it. Excessive screaming, yelling, singing, loud talking, coughing, throat clearing, even whispering causes the vocal folds (cords) to close or bang together with excessive force. Imagine if you clapped your hands together very hard, over and over for an extended period of time. They would eventually get chafed. If the action continued, the chafing would lead to callouses. The effect of your vocal cords banging together with force inside your larynx is the same. Callouses will develop. The difference is, while the skin on your hands is sensitive and the pain of callouses would motivate a person to stop engaging in that behavior, your vocal cords do not have pain sensors, so there is no soreness to alert the person of the damage.

So how do you know you have nodules?

When nodules appear on the vocal cords, the bumps prevent the folds in the larynx from closing together when producing sound. Because the folds do not close all the way, speech comes across as raspy, breathy, or hoarse. In singers, often they notice a decrease in pitch range. Sometimes, a person might have a “lump in your throat” sensation.

When these symptoms are present and last for more than two or three weeks, you should visit an otolaryngologist (ear, nose, and throat doctor). Your doctor can perform the proper tests to evaluate for the presence of nodules.

What is the treatment for nodules?

Only very rarely do nodules require surgical removal, though that can be a last resort option. Typically, the first stage of treatment is behavioral intervention. If you are suffering from nodules, you must become conscientious of your speech and behavior patterns. Avoid yelling and screaming, and reduce the noise in the room that would cause you to need to speak loudly. For example, turn off the television or radio before speaking. When singing, be careful not to “growl” your voice. Singer Adele, for example, is an awesome performer, but I foresee vocal fold problems down the road.

Avoid smoking or any other activity that causes coughing, excessive throat clearing, or that would dry out the membranes of your vocal folds. Keep the membranes hydrated by drinking plenty of water. Dry vocal cords are more vulnerable to injury. Eliminate drinks with caffeine or alcohol.

Tension and stress can be a factor in preventing the healing of nodules. Try relaxation or other stress reducing exercises such as yoga.

While waiting for the nodules to heal, decrease your talking as much as possible, or any other use of your vocal mechanisms. Avoid whispering, as this can cause a strain on your cords.

Just like any sore or abrasion, it can take weeks for nodules to disappear altogether. You need to rest your voice for the entire duration of the healing process. And remember, whatever behavior caused the nodules to develop in the first place will cause them to recur. Preventing future nodules requires a commitment to changing your vocal behaviors and lifestyle on a permanent basis.