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Vocal fold nodules are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds. Although diagnosis involves a physical examination of the head and neck, as well as perceptual voice measures, visualization of the vocal nodules via laryngeal endoscopy remains the primary diagnostic method. Vocal fold nodules interfere with the vibratory characteristics of the vocal folds by increasing the mass of the vocal folds and changing the configuration of the vocal fold closure pattern. Due to these changes, the quality of the voice may be affected. As such, the major perceptual signs of vocal fold nodules include vocal hoarseness and breathiness. Other common symptoms include vocal fatigue, soreness or pain lateral to the larynx, and reduced frequency and intensity range. Airflow levels during speech may also be increased. Vocal fold nodules are thought to be the result of vocal fold tissue trauma caused by excessive mechanical stress, including repeated or chronic vocal overuse, abuse, or misuse. Predisposing factors include profession, gender, dehydration, respiratory infection, and other inflammatory factors.

For professional voice users as well as individuals who frequently experience hoarseness, vocal hygiene practices are recommended for the prevention of vocal fold nodules and other voice disorders. Vocal hygiene practices include three components: regulating the quantity and quality of voice use, improving vocal fold hydration, and reducing behaviours that jeopardize vocal health. About 10% of nodules resolve on their own, which is more likely if they are smaller and the onset more recent. Treatment of vocal fold nodules usually involves behavioural intervention therapy administered by a speech-language pathologist. In severe cases, surgery to remove the lesions is recommended for best prognosis. In children, nodules are more common in males, in adulthood, they are more common in females.

Regulating Voice Use
For individuals who work with their voice (e.g., singers, actors, teachers, stock brokers) voice training that includes vocal function exercises (VFEs) may help to reduce undue vocal strain. Furthermore, recommendations for voice professionals include warm-up and cool-down exercises for the voice to reduce strain. Additionally, using amplification devices, such as speakers or microphones, is recommended for individuals who speak to large, and even small groups or in the presence of background noise.

Improving Vocal Fold Hydration
Staying hydrated decreases the pressure that the vocal folds exert on one another by ensuring sufficient lubrication by mucosa, increasing the efficiency of vocal fold oscillation during speech, and promoting a healthy voice quality. Consumption of caffeine in large quantities is dehydrating and is therefore implicated in an increased risk of vocal fold nodules. Reducing the amount of caffeine consumed regularly can prevent dehydration of the vocal folds and subsequent lesion formation.

Reducing Behaviours that Jeopardize Vocal Health
Behaviours such as frequent throat clearing, shouting, speaking over background noise, and hard crying are associated with an increased risk of developing nodules and other vocal pathologies. Furthermore, unconventional voice practices such as speaking in the falsetto register, cause excessive strain and may result in nodules. The avoidance of damaging vocal behaviours may prevent the formation of nodules. Tobacco, alcohol, certain medications, and recreational drugs have also been implicated in pathologies of the vocal folds. Reducing exposure to these substances has been shown to reduce one's risk of nodules. Other behaviours that are implicated in vocal fold nodules include poor sleeping habits and poor nutrition.

Behavioural Treatments
Behavioural voice therapy with a speech-language pathologist is recommended. This usually involves vocal training, voice therapy, and, occasionally, vocal rest.[5] A speech-language pathologist will determine treatment course based on a number of factors, including patient compliance and the severity of the pathology. Treatment techniques focus on educating individuals, often professional voice users, about vocal hygiene and safe voice practices (see prevention). Maladaptive and phonotraumatic behaviours are identified and then minimized or eliminated. Most therapy will address the reduction of collision forces between the vocal folds, ensuring sufficient pulmonary support while speaking, and optimizing resonance of the larynx and other structures of the vocal apparatus. This may entail adaptation of an individual's breathing pattern or reshaping of their vocal tract through behavioural modifications. While behavioural modification often results in a reduction in the size and severity of vocal fold nodules and an improvement in voice quality, lesions are unlikely to resolve completely.

Surgery
In rare cases, surgery may be required when behavioural interventions are ineffective. Surgical treatments are considered in cases of unresolved dysphonia which negatively impacts the patient's quality of life. Removal of vocal fold nodules is a relatively safe and minor surgery. However, those who sing professionally or otherwise should take serious consideration before having surgery as it can affect the ability to sustain phonation, as well as alter the vocal range. While the patient is subdued under general anesthesia, long thin scissors and scalpels or CO2 surgical lasers might be used to remove the nodules. Microsutures are sometimes used to close the incision. Vocal rest for a period of 4 to 14 days is recommended post surgery to facilitate healing.