​Vocal cord nodules are lesions or swelling of the vocal folds, which are more commonly known as the vocal cords. Vocal nodules are one of the most common causes of pediatric dysphonia (losing your voice). Nodules typically occur after extended periods of trauma or abuse to the vocal cords, such as prolonged screaming, intubation, laryngitis, or other surgical or medical conditions that affect the vocal folds.


  • Hoarseness
  • Strain
  • Breathiness
  • Losing your voice
  • Scratchy voice
  • Soft voice
  • Pain when talking
  • Vocal fatigue


An evaluation for vocal cord nodules requires a multidisciplinary team approach. The evaluation consists of several components:
Laryngeal Visualization: Prior to receiving a speech therapy voice assessment, the child should be seen by a pediatric Ear Nose Throat doctor, who will perform an endoscopic evaluation in order to visualize the larynx and diagnose vocal nodules. During the endoscopic evaluation, the ENT will also be able to evaluate additional factors that may be contributing to your child’s voice problem.
Medical History: During the speech therapy voice evaluation, we will first take a thorough history of the voice problem in order to obtain the following information:
  • If any event initiated the onset of your child’s voice problem
  • How long your child has had voice issues
  • How your child’s voice difficulty is affecting him or her in social and home situations
  • If anything improves or makes your child’s voice worse
  • If your child has ever had periods of dysphonia (losing her or her voice)
  • Any medical, lifestyle, or emotional factors related to the child’s voice problem
Perceptual Judgment: We will also do a perceptual assessment of your child’s vocal quality, including roughness, breathiness, strain, and weakness.
Acoustic Assessment: Your child will participate in a series of vocal tests in order to evaluate maximum phonation time, pitch variation, and vocal loudness.


Treatment includes teaching the child vocal hygiene, such as not yelling, hydrating frequently, and not fatiguing the voice. Voice relaxation techniques are also used, such as diaphragmatic breathing exercises, lip trills, tongue trills, and laryngeal massaging.   
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