Vocal nodules are swellings of the vocal cords due to voice abuse.
Vocal nodules are not uncommon and can occur at any age from 2 upwards.
Excessive strain on vocal cords due to screaming in the younger child
and shouting in the older child. This causes minor bleeds into the
edges of the vocal cords with consequent thickening.
The child is usually a shouter or screamer. The main symptom is
hoarseness. It is persistent but its severity can be variable. It is
often worse if there has been excessive vocal activity on the preceding
day. Examination of the larynx is sometimes possible in outpatients and
shows the typical appearance of nodules on the junction of the front
and middle thirds of both vocal cords.
The condition is not injurious to health but can cause embarrassment
to older children particularly if the voice gives out while talking.
The most important investigation is examination of the larynx. This
is mainly done to exclude other more serious causes of hoarseness,
particularly laryngeal papillomas. It is often possible to do this with
a mirror or telescope via the mouth or nose in outpatients but a
general anaesthetic may be necessary to examine the child's larynx
No treatment may be needed, because the symptoms are relatively minor and the condition is self-limiting.
Voice rest if carried on for long enough, is effective at solving the
problem. Speech therapy is also helpful in modifying vocal behaviour
particularly in the older child but is not always successful because the
habit of voice abuse can be difficult to break.
Removal of the nodules via the mouth by the operation of
microlaryngoscopy with or without lasering can be helpful, but nodules
are prone to recur if the vocal behaviour has not changed.
Vocal nodules eventually resolve spontaneously in the majority of children.