Small chronic swellings that appear in the junction of the middle and anterior thirds of the vocal fold. These swellings, or nodules (nodes), are vibratory injuries caused by vocal overuse. The most obvious symptom of medium-to-large nodules tends to be hoarseness. The top symptoms for nodules of any size may include: 1) difficulty with high, soft singing; 2) day-to-day variability of vocal capability and clarity; 3) a sense of increased effort to produce voice, especially for singing; 4) reduced endurance, so that the voice becomes husky or “tired” after less voice use than formerly; and 5) phonatory onset delays, when there is a slight hiss of air before the voice “pops in.”
How nodules happen:
When you overuse your voice, your body tries to cushion the vocal cords by pooling together edema (fluid) beneath the vocal cord mucosa (the surface layer of the cords); this pooled edema is like a small, low-profile blister on your finger. If after a few days you stop overusing your voice, the edema disperses readily, within a few days, and this “blister” on the vocal cords vanishes. If, however, the amount or manner of voice use remains excessive for many weeks or months, then more chronic swelling materials (no longer just edema fluid) are laid down by the body, and the vocal cords develop true nodules.
Why nodes affect the voice:
In either case (acute swellings or chronic nodules), this injury to the mucosa can impair the voice in two ways: it reduces the vibratory flexibility of the mucosa, and it interferes with the accurate match of the cords when they come together to produce voice. This impairment causes the voice to be hoarse or, more subtly, to suffer from onset delays, difficulty with high notes, and other similar problems.
Nodules will often dissipate, with the help of rest and perhaps speech/voice therapy, over a period of weeks or months. Sometimes, the swellings are so stubborn that surgery is required.
Audio with photos:
Vocal nodules’ effect on the voice, BEFORE surgical removal (see this patient’s photos just below):
Same patient, seven weeks AFTER surgical removal of the vocal nodules: