OVERVIEW

What are vocal cords?

The vocal cords are the sound-producing organs in the human body, primarily responsible for speaking, singing, and vocalization. There are two vocal cords, resembling white bands with smooth edges. The front ends of the two vocal cords are connected, while the rear ends can open and close. The average length of an adult male's vocal cords is about 21 mm, while that of an adult female is about 17 mm.

The vocal cords are located in the neck, roughly at the level of the Adam's apple in males. They serve as a critical passage in the throat, positioned above the larynx and connected to the airway below. Figuratively speaking, the vocal cords act like two doors at the entrance of the airway that can open and close. The space between the two vocal cords is called the glottis, through which air passes in and out of the trachea and lungs.

What are the functions of the vocal cords?

In terms of size, the vocal cords are very small organs relative to the entire human body, but their functions are among the most vital for survival.

The two primary functions of the vocal cords are sound production and respiration, achieved through vertical vibrations and horizontal opening/closing movements.

• During sound production, the two vocal cords close and vibrate to produce sound.

• The movement of the vocal cords is closely related to breathing. Under normal circumstances, the vocal cords fully open during respiration, allowing sufficient air to pass through the glottis into and out of the lower airway.

What are the symptoms and effects of vocal cord problems?

Vocal cord issues primarily affect sound production and breathing.

• Effects on sound production mainly depend on vocal cord vibration and closure.

If vocal cord vibration is impaired—such as weakened or absent vibration, or asynchronous vibration (one side vibrating faster than the other)—the resulting voice may become hoarse, rough, or altered in pitch, with symptoms like difficulty speaking loudly, effortful speech, and fatigue. Almost all vocal cord disorders affect vibration to some extent.

Problems with vocal cord closure include incomplete closure or excessive tightness. If the vocal cords do not close tightly enough, air leakage occurs during speech, leading to symptoms like hoarseness, breathiness, and effortful speech. If the vocal cords close too tightly, they press against each other, causing symptoms such as a shaky or interrupted voice, strained speech, and fatigue.

• Effects on breathing mainly depend on changes in the size of the glottis.

If the glottis becomes too narrow, insufficient air enters the airway, leading to symptoms like shortness of breath, suffocation, or even choking in severe cases.

Common conditions include vocal cord paralysis. In unilateral vocal cord paralysis, symptoms like breathlessness and suffocation often occur during physical activity (e.g., climbing stairs or running), while breathing remains normal during daily or low-intensity activities. In bilateral vocal cord paralysis, the glottis narrows significantly, severely impairing breathing and potentially requiring a tracheotomy.

What are vocal cord nodules?

Vocal cord nodules are a common benign hyperplastic lesion of the vocal cords and one of the most frequent causes of voice disorders.

Visually, vocal cord nodules appear as small, pointed, grayish-white protrusions or localized mucosal swelling. They are typically located symmetrically on the anterior-middle third edges of both vocal cords, though occasionally one side may be larger, the other smaller, or only one side may be affected. Rarely, a vocal cord nodule may appear on one side with a polyp on the opposite side.

SYMPTOMS

What are the symptoms of vocal cord nodules?

The earliest and most common symptom of vocal cord nodules is hoarseness. Typically, the voice may sound fine in the morning but worsens with prolonged speaking, improving after rest.

Other symptoms include difficulty hitting high notes, a lowered vocal range, vocal fatigue, and breathiness.

The severity of hoarseness depends on the size and location of the nodules—the larger and more forward the nodules, the more pronounced the hoarseness.

Can vocal cord nodules become malignant?

Vocal cord nodules are benign lesions and do not turn malignant.

CAUSES

What causes vocal cord nodules? Which groups are commonly affected?

Vocal cord nodules or polyps are often related to improper or excessive voice use, such as speaking for too long, talking loudly for extended periods in noisy environments, screaming, or shouting. Therefore, occupational voice users like teachers, salespeople, singers, hosts, and restaurant servers are high-risk groups.

Additionally, vocal cord nodules are the most common cause of hoarseness in school-aged children. Most of these children tend to shout loudly or cry frequently, with boys being more affected than girls.

DIAGNOSIS

What are the differences between vocal cord nodules, vocal cord polyps, and vocal cord cysts?

Vocal cord nodules, polyps, and cysts are the three most common benign vocal cord conditions that cause voice disorders. Their symptoms are largely similar, primarily characterized by hoarseness. Distinguishing among them relies mainly on a doctor's visual examination under laryngoscopy, with the following key differences:

• Location: Vocal cord nodules are mostly located at the anterior-middle third of the vocal cord edges and are usually bilateral and symmetrical. Vocal cord polyps are more commonly unilateral, though they also frequently occur at the anterior-middle third of the vocal cord edges; however, polyps in other locations are not uncommon, and bilateral polyps are rare. Vocal cord cysts typically develop on one side.

• Appearance: Vocal cord nodules appear as small, grayish-white, pointed protrusions. Vocal cord polyps are translucent, pale, and edematous, resembling lychee flesh, with sizes varying significantly among patients (ranging from a few millimeters to several centimeters). Some polyps may be pedunculated (like a watermelon attached to its vine). Vocal cord cysts are light yellow, round, and plump protrusions, resembling spheres or hemispheres with a very smooth surface.

• Treatment: Speech therapy is the first-line treatment for vocal cord nodules, while surgery should be considered cautiously. Small vocal cord polyps may also be treated with speech therapy, but larger ones often require surgical removal. Vocal cord cysts usually necessitate surgical excision.

• Recurrence: Vocal cord nodules and polyps may recur, whereas vocal cord cysts are less likely to do so.

In summary, patients often cannot determine which of these three vocal cord conditions they have based on symptoms alone. Even doctors may not always accurately diagnose them visually, sometimes requiring postoperative pathological examination for confirmation.

TREATMENT

What to do after developing vocal cord nodules?

• Speak less

The most important measure after discovering vocal cord nodules is vocal rest (i.e., speaking less)! Avoid speaking whenever possible.

At the same time, correct poor speaking methods and habits, such as limiting speaking time, avoiding shouting (especially in children), excessive laughter, prolonged loud talking in noisy environments, excessive coughing or frequent throat clearing, and exposure to dust or smoke. Also, refrain from smoking, alcohol, and spicy or irritating foods. Vocal rest should last at least 1–2 weeks.

• Speech therapy

Speech therapy is the preferred treatment for vocal cord nodules.

• Surgery

Surgical removal may be considered for larger nodules, significant growth, severe hoarseness, or cases unresponsive to vocal rest and speech therapy. Surgery for vocal cord nodules should be approached cautiously, especially for children, and is generally not recommended.

What medications are used to treat vocal cord nodules? Can medication alone shrink the nodules?

Currently, there are no clearly effective medications for vocal cord nodules, and drugs are not a primary treatment method.

What is speech therapy for vocal cord nodules?

Simply put, it involves systematic vocal training under the guidance of a professional to improve pronunciation, including correcting incorrect or harmful vocal habits and learning proper vocal techniques.

What are the benefits of speech therapy for vocal cord nodules?

Speech therapy is internationally recognized as the first-line treatment for vocal cord nodules.

Speech therapy has clear and significant effects. Most patients experience a reduction or disappearance of nodules, and even if nodules persist, voice quality often improves noticeably.

Additionally, for those undergoing surgical removal, pre- and post-operative speech therapy is essential to prevent recurrence.

Can vocal cord nodules recur?

Vocal cord nodules are closely related to speaking habits and vocal techniques. If these contributing factors are not addressed, recurrence is likely.

DIET & LIFESTYLE

What should patients with vocal cord nodules pay attention to in daily life?

For those with vocal cord nodules, the most important things are quitting smoking and speaking less. At the same time, avoid speaking too loudly, shouting, etc.

Since actions like coughing and throat clearing can also irritate the vocal cords, try to avoid dust and smoke, and eat less spicy or irritating foods.

PREVENTION

How to Prevent Vocal Cord Nodules?

Preventing vocal cord nodules or polyps primarily involves avoiding vocal misuse or overuse, such as speaking loudly, shouting, excessive talking, prolonged speech, frequent coughing or throat clearing, and speaking in pitches that are too high or too low.