Vocal nodules are hard, rough, noncancerous growths on your vocal cords. They can be as small as a pinhead or as large as a pea.

You get nodules from straining or overusing your voice, especially from singing, yelling, or talking loudly or for a long period of time.

Vocal nodules go by other names based on their cause. They’ve been called “singing nodules,” “screamer’s nodules,” and “teacher’s nodules.”

Your vocal cords, also called vocal folds, are V-shaped bands of tissue that run down the middle of your voice box. When you talk or sing, air from your lungs rushes up through your vocal cords and makes them vibrate open.

If you overuse your voice or use it incorrectly, you can irritate your vocal cords. Over time, the irritated areas harden until they have the texture of little callouses. They’ll continue to grow if you don’t rest your voice.

These growths can prevent your vocal cords from vibrating normally. A lack of vibration will change the pitch and tone of your voice.

Nodules typically affect people who sing or talk a lot, such as:

  • cheerleaders
  • coaches
  • radio hosts
  • salespeople
  • teachers
  • preachers

Overuse isn’t the only reason people get vocal nodules. A few other possible causes include:

  • smoking
  • regular alcohol use
  • sinusitis
  • allergies
  • tensing your muscles when you talk
  • side effects from medication
  • hypothyroidism

Anyone can get vocal nodules, including children. But these growths are more likely to form in women between the ages of 20 and 50 and in boys. The increased risk in these groups of people may have to do with the size of their larynx.

Nodules are also a common problem among singers.

Voice changes

Vocal nodules change the sound of your voice, making it:

  • hoarse
  • raspy or scratchy
  • tired-sounding
  • breathy
  • crack or break
  • lower-pitched than usual

Limited singing range

Singers can have a hard time reaching higher octaves because nodules reduce their range. Some people lose their voice entirely.

Pain

Pain is another common symptom of nodules. It may feel like:

  • a shooting pain that goes from ear to ear
  • neck pain
  • a lump stuck in your throat

Other symptoms

Other possible symptoms of vocal nodules include:

  • coughing
  • a constant need to clear your throat
  • tiredness

You should see a doctor if you’re hoarse or you’ve had other symptoms of vocal nodules for more than two or three weeks.

To treat vocal nodules, you should see an otolaryngologist, also known as an ear, nose, and throat (ENT) doctor. You might also see an allergist if you think allergies are causing or contributing to the problem.

An ENT may ask whether you’ve been singing, screaming, or doing other activities that strain your voice. They’ll examine your head and neck and look at the back of your throat with a special mirror.

To view your vocal cords more closely, the doctor may place a special lighted scope through your nose or mouth into your larynx. Looking through this scope can help them see your nodules, which will look like rough patches on your vocal cords.

You may be asked to talk at different pitches while the doctor watches your vocal folds vibrate. This may be recorded on video.

The doctor may remove a small sample of tissue and test it to make sure the growth isn’t cancerous.

Treatment starts with vocal rest. You’ll need to avoid singing, yelling, and whispering to bring down swelling and give nodules time to heal. Your doctor will tell you how long to rest.

Voice therapy is another part of treatment. A speech-language pathologist (SLP) can teach you how to use your voice safely, so you won’t overuse it in the future.

Get treated for any medical conditions that may have caused your vocal nodules, such as:

If your vocal nodules don’t go away after a few weeks or they’re very large, you may need surgery to remove them.

Phonomicrosurgery is used to treat vocal nodules. A surgeon uses tiny instruments and a microscope to remove nodules without damaging surrounding healthy tissue.

To avoid getting nodules in the future, address the factors that cause them — such as smoking, stress, and overuse.

Smoking

If you want to quit or reduce how much you smoke, ask your doctor about methods such as medication and counseling. Cigarette smoke dries out and irritates your vocal cords, preventing them from vibrating properly when you sing or speak.

Smoking can also cause damaging acid from your stomach to back up into your throat and irritate it.

Stress

Stress can also contribute to vocal nodules. When people are under stress, they may tighten the muscles in their throat and neck.

Relieve stress with relaxation techniques such as:

To learn how to care for your voice, see an SLP. They can teach you how to adjust your voice when you talk or sing to avoid injuring your vocal cords.

Your outlook depends on how well you care for your vocal nodules and how you protect your vocal cords in the future. Most nodules will go away with rest and retraining. If you keep overusing your voice, you may be stuck with them long-term.