Vocal nodules or knots on the vocal cords are limited protrusions on the verge of the anterior and middle thirds edge of the vocal cords, and they are usually benign lesions of the vocal folds of children and women. Their etiology is indisputable because it is proven that they are the result of forced hyperkinetic phonation type in women and children who blatantly talk a lot.
The vocal nodules formation mechanism represents a collision of middle parts of vocal cords (described as the border of the anterior and middle third of loose edge of the vocal cords) and it matches exactly to half membrane part of the vocal cords. Namely, those are the parts of the vocal cords which, during phonation, vibrate with maximum amplitude, and the mechanical clash of those parts with hyperkinetic phonation leads to tissue damage and tissue reaction in the form of protrusions of loose edge.
The occurrence of vocal nodules is most often a consequence of long vocal abuse, it mostly occurs in women that are maximally professionally vocally engaged and speech dominant children, and sometimes also children with attention deficit syndrome. These are the most affected groups. However, vocal nodules can develop rapidly after acute voice stress, often in combination with acute laryngitis, or viral illness of upper respiratory tract. Then they are barely visible, soft and called prenodules. Otherwise, the nodules may be edematous soft-and fibrosis hard and after a certain time they are created from soft nodules.
Although these are small growths on the vocal cords, hoarseness can be considerable, because this is a combined mechanism of primary hyperkinesia (that caused the vocal nodules), the noise generated in the voice produced by passing the air through partially closed glottis, and the secondary hyperkinesia. Therefore, vocal nodules may interfere with professional activity and must be treated because constant stress in patients with vocal nodules leads to further damage to important parts of the vibratory vocal cords.
Vocal Nodules Treatment
Laryngeal stroboscopy can show nodule type. Soft nodules can be treated conservatively with voice exercises, medically, while the hard nodules are treated with surgical excision in a very cautious microlaryngoscopy technique, followed by the obligatory voice therapy with the aim to change the way of phonation so nodules would not relapse. Precisely because of the manner of phonation which is the part of the default behavior (and sometimes professional) these nodules often recur. A favorable fact is that in boys during puberty they retreat by themselves, as opposed to vocal nodules in girls, which often last even after puberty, narrowing their choice of future occupation.
Vocal nodules in children often spontaneously regresses until puberty so they do not represent a greater problem and there is no need to remove them surgically. But in a number of children the disappearance of vocal nodules in certain places develops chronic changes that lead to permanent hoarseness in adults, which is often difficult to treat.