Vocal Nodules

Vocal cord nodules are small growths on a child’s vocal cords. They are the main cause of chronic (long-term) hoarseness in children. Vocal cord nodules are not cancer, but they can harden and cause problems if they are not treated.

Chronic hoarseness is the main symptom of vocal cord nodules. Other symptoms include:

• A “breathy” voice
• A lower voice
• Pain that moves from ear to ear
• The feeling of having a lump in the throat
• Neck pain

See an ear, nose, and throat (ENT) specialist (otolaryngologist) if your child is using their voice in a way that could harm their vocal cords, or if they have had a hoarse voice for several weeks.

The following can cause irritation and nodules in the vocal cords when done over a long period of time:

• Crying, screaming, and yelling
• Straining the voice when speaking or singing
• Singing or talking from the throat, not the diaphragm
• Unbalanced vocal range (high one minute, lower the next)
• Talking in a loud voice or very quickly

Medical conditions that can cause irritation and nodule growth include:

• Secondhand smoke or smoke inhalation
• Paralysis of the vocal cords (loss of nerve function)
• Chronic sinus infections
• Allergies
• GERD (Gastroesophageal reflux disease)
• Low thyroid function (hypothyroidism)
• Radiation therapy

To find out if your child has vocal cord nodules, the doctor will ask about your child’s medical history and do a physical exam. The doctor may recommend that your child see a speech-language specialist or a neurologist (nervous system specialist) for further evaluation.

Tests may be needed to confirm or rule out the presence of vocal cord nodules. The most common test is called a laryngoscopy [lar-in-GOSS-kuh-pee]. During this test, the doctor uses a narrow tube containing a miniature camera and light to look at the vocal cords. The tube may be flexible (soft), or rigid (hard). The tube is passed through the mouth or nose and into the throat. Your child may be asked to sing, swallow, or cough so the doctor can see the vocal cords in action.

Treatments for vocal cord nodules include:

• Speech-language therapy. This is the most common treatment. Speech-language therapists can work with your child to help them make changes in their speech habits, such as:
  • Learning to breathe correctly when speaking and singing
  • Talking slowly and clearly
  • Protecting the vocal cords when cheering or yelling
• Managing medical conditions. This may include testing for and treating conditions like GERD or thyroid disease.
• Making changes in your child’s diet. Your doctor may recommend that your child give up or eat less of foods that irritate the vocal cords (such as caffeine and soda).
• Surgery to remove growths. This is rarely recommended for children and only when the nodules are very large or have been there for a long time.

Helping your child change their behavior is the best way to avoid getting vocal cord nodules. Encourage your child to do prescribed speech-language exercises and reward them when they do.

Follow all recommendations from your child’s doctor regarding any medicines or diet changes to treat any medical conditions.

KidsHealth

American Speech-Language-Hearing Association

Vocal cord nodules are small growths on a child’s vocal cords. They are the main reason kids get chronic (long-term) hoarseness. Your child is more likely to get vocal cord nodules if they scream and yell a lot or talk loudly over a long period of time. Other medical conditions can also cause vocal cord nodules.