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Vocal Nodules

What else are they called?

  • Nodules.
  • Vocal cord nodules.
  • Vocal fold nodules.
  • Singers’ nodules.
  • Screamers’ nodules.

What are they?

  • Vocal nodules are non-malignant calluses on the vocal cords.
  • They may be large or small.
  • They may be soft or hard (fibrosed).
  • They typically appear in the same position on both vocal cords (although occasionally only one nodule forms).

What causes them?

  • Trauma to the vocal cords because of excessive muscle tension and effortful forcing of the voice. This is typically caused by:
    • Vocal abuse (e.g. shouting, screaming, excess alcohol, smoking, throat clearing and coughing, talking for long periods without adequate rest).
    • Vocal misuse (e.g. using a pitch that is too high/too low, excessive singing/humming with poor vocal technique).

What are the typical symptoms?

People with vocal nodules may experience some, or all, of the following symptoms.

  • Hoarseness/roughness. This usually begins gradually: at first it is sporadic but eventually it becomes continuous.
  • Breathiness.
  • Lower pitch.
  • Restricted pitch range.
  • Reduced volume.
  • Breaks in phonation, i.e. the voice seems to ‘come and go’ with voiceless segments in the stretch of talk.
  • Soreness in the larynx after using the voice vigorously.
  • A feeling of “something in my throat”.
  • Throat clearing and coughing.
  • Voice deteriorates with use.
  • Speaking is effortful.

What will I have to do to improve my voice?

Each person’s symptoms, and the stage of growth of the vocal nodules, will be slightly different. This will influence what you personally need to do to improve your voice. However, intervention typically focuses on the following.


  • Surgical intervention is avoided if at all possible.
  • Hard (fibrosed) vocal nodules will, however, need to be surgically removed.
  • Prior to surgery it is helpful to receive advice from a voice therapist. [Often a trial course of therapy is recommended prior to making a final decision to operate.]
  • Following surgery, you will need to rest the voice (without whispering) for at least three days.
  • You will also require a course of voice therapy following surgery to help you eliminate the damaging vocal behaviors that led to the nodules.

NB: Whilst surgery to remove vocal nodules is nowadays a safe and quick procedure, it is not without consequences. Removal inevitably causes scarring of the vocal cords. For many non-professional voice users the effects of this on the voice quality may be negligible. However, for professional voice users such as singers, the changes can be significant. It is, therefore, essential to eliminate all possible causes of vocal misuse and abuse as soon as possible and to receive advice on improving your vocal technique for both speaking and singing.

Voice therapy

  • Voice rest may still be recommended even if you have not had surgery.
If the vocal nodules are soft, you will require a course of voice therapy. You will be shown how to:

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