Nodules are benign masses on the vocal fold tissue of various sizes. 

Triggered By

  • Chronic laryngitis
  • Vocal fold minimal lesions
  • Gastrooesophagyeal reflux 
  • Laryngopharyngeal reflux
  • Gastritis
  • the presence of Helicobacter pylori


  • Vocal hoarseness
  • Difficulty in using the voice
  • Aching and pain while speaking
  • Recieved postural changes 
  • Vocal aging


  • Vocal misused
  • Overuse
  • Phonatory Trauma
  • Muscle Tension Patterns

Underlying Factors

  • Age  (Women tend to suffer from nodules later in their lives. In case of children, analyzing the behaviour of them provides an effective approach in their voice assessment)
  • Gender 
  • Occupation (smoking habits, teaching level and prior training in speech disorders and their prevention, in case of teachers. The younger female teachers are more likely to suffer from functional dysphonia due to the presence of a vocal fold nodule than male teachers)
  • Personality Traits 
  • Size of the nodule

Assessment Method

  • Range of Voice 
  • Maximum Phonation Time
  • Mean Air-Flow Rate
  • Acoustic Analysis (jitter & shimmer)
  • Dysphonia Severity Index (RBH)


The treatment is determined after a stroboscopic examination and acoustic analysis. 

Voice therapy is highly effective in treating the nodules, improving the voice, quality of phonation and more importantly provides relief from habitual muscle tension patterns.

While the surgery provides a complete healing of the vocal fold tissue the patient generally requires post-operative voice therapies in order to prevent the recurring of nodules due to the habitual muscle tension patterns.