Vocal Cord Nodules Treatment: A Helpful Guide For SLPs

Vocal nodules are lesions (growths) on the vocal folds. They can cause vocal hoarseness, fatigue, and pain.

This article covers 7 effective vocal cord nodules treatments to inform your speech therapy practice. Plus, you’ll get a FREE patient education PDF!

vocal cord nodules treatment
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What Are Vocal Cord Nodules?

Around 2% to 17% of the population have vocal nodules (Won et al., 2016).

Vocal nodules are benign lesions typically located at the midpoint of the vocal folds (Baali et al., 2024). They are caused by overuse or misuse of the voice, also known as phonotrauma. Vocal nodules are almost always bilateral (Informedhealth.org, 2024).

Phonotraumatic behaviors that can cause vocal nodules include yelling, excess throat-clearing, speaking too loudly, and screaming (Naqvi & Gupta, 2023). 

Read How To Treat Phonotrauma for more on this topic.

Signs and symptoms of Vocal nodules

People with vocal cord nodules may experience and/or report the following signs and symptoms:

  • Vocal hoarseness
  • Vocal raspiness
  • Breathiness when speaking
  • Difficulties with maximum phonation time (MPT)
  • Decreased vocal pitch range
  • Vocal fatigue
  • Strain when speaking
  • Throat and/or neck pain
  • Too high or too low of a pitch (Informedhealth.org, 2024)

Vocal fold nodules are more common in younger patients (under 19 years old), females, and professional voice users such as teachers and singers (Won et al., 2016).

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Vocal Cord nodules treatments

There are both behavioral and medical options for treating vocal cord nodules. A conservative approach of vocal hygiene and voice therapy is often tried first before recommending surgery (Lloyd, n.d.b.)

Below are 7 effective vocal cord nodules treatments, including voice therapy options, our free (!) patient education handout, and when to refer out for surgery or medications.

1. Voice rest For Vocal Cord Nodules

Voice rest is often recommended after vocal cord nodules have been diagnosed by an otolaryngologist (Lloyd, n.d.b.)

Voice rest is using the voice less. This means talking/singing less, avoiding talking if there’s background noise, and avoiding harsh whispering.

2. Vocal Hygiene For Vocal Cord Nodules

Vocal hygiene can help most patients with vocal cord nodules.

A 2018 randomized clinical trial found that a good vocal hygiene program can resolve benign vocal fold nodules without surgery (Hoyosa et al.) In fact, the most benign lesions in the study resolved without additional voice therapy, much less surgery.

Good vocal hygiene is a set of behaviors that optimize vocal health and voice production (Brewer & Aparo 2021). Teach your patient to be mindful of their vocal behaviors and the medical and environmental factors impacting their voice.

What to include in a good vocal hygiene program:

  • Educate about the anatomy and physiology of the voice (download our free PDF below!)
  • Educate on how and why vocal cord nodules form
  • Explain the impact of GI reflux and how to prevent it (dietary, sit upright after eating, raise head of bed)
  • Review harmful habits to decrease/stop (avoid smoking, dust, yelling, whispering, triggering foods)
  • Review healthy habits to add (drink water, add humidification if in a cold and dry climate)
  • Problem-solve with your patient and their family about how to improve vocal hygiene in their lives

(Hoyosa et al., 2018)

Free Vocal Fold Nodules Illustration PDF!

Vocal Fold Nodules Patient Education @ 2025 adultspeechtherapy.coDownload

Illustrated by Chung Hwa Brewer, CCC-SLP, author of The Adult Speech Therapy Workbook. Below, Chung demonstrates how to use your new PDF to educate patients.

3.  Resonant voice therapy for vocal cord nodules

Resonant voice therapy has been shown to improve vocal quality in patients with vocal nodules (Lloyd, n.d.b.) The goal of this therapy is for patients to produce a strong, clear voice with the least amount of vocal effort. 

A resonant voice feels like vibrations and resonance at the front of the face (lips, nose, cheeks, etc.)

While doing exercises, your patient will focus on feeling the vibration at the front of their face and on feeling an easy (not tense) voice.

They can start with humming, then progress to nasal consonant exercises, nasal-loaded words, phrases loaded with nasals with chant talk, the same phrases with normal intonation, and so on.

Well-known resonant voice therapy protocols and strategies include Lessac-Madsen’s Resonant Voice Therapy, Joseph Stemple’s Resonant Voice Therapy, and Y-Buzz. Adventures in Voice is a voice program for children.

Read How To Do Resonant Voice Therapy.

4. Semi-occluded vocal Tract (SOVT) exercises For vocal cord nodules

A semi-occluded vocal tract creates intraoral pressure that takes effort off of the vocal folds. Patients usually do this by partially occluding (narrowing and rounding) their lips.

The idea is that the vocal folds can heal when effort is taken off of them.

Ask your patients to focus on voicing with an easy, forward focus while feeling the vibrations at their rounded lips. Examples of SOVT exercises include:

  • Straw phonation (blow, hum, then vocal glide)
  • Lip trills (buzz then vocal glide)
  • Tongue trill (rolling the ‘r’)
  • Voiced fricatives (sustained then vocal glide)
  • Humming
  • Y-Buzz (Lloyd, n.d.a.)

5. Conversation Training Therapy (CTT) For vocal cord nodules

Conversation Training Therapy is an approach that uses conversation to treat voice disorders. It was developed by Jackie Gartner-Schmidt and Amanda Gillespie. CTT aims to take tension and effort off of the vocal folds through the functional treatment modality of conversation.

During CTT, the clinician focuses on:

  • Clear speech
  • Increasing the patient’s sensory awareness of their voice
  • Negative practice (switching between their “old” and “new” voice to compare how each sounds and feels)
  • Basic training gestures
  • Prosody

Read a step-by-step guide on How To Do Conversation Training Therapy.

6. Breathing Exercises For vocal cord nodules

With proper breath support, effort is offloaded from the vocal folds, giving them a chance to heal.

In this video, speech-language pathologist Alisha Kleindel shows you how to do diaphragmatic breathing to support a healthy voice.

7. Medication and phono-surgery

Medications can help manage underlying contributors of vocal fold nodules, such as reflux or allergies. Have your patient consult with their physician and/or otolaryngologist as needed.

If a patient’s vocal nodules are hard, too invasive, or not responsive to voice therapy, then surgery and/or a medical procedure can be an effective option (Lloyd, n.d.b.; Baali et al., 2024).

Learn how to do evidence-based voice treatments in our *new* Adult Speech Therapy Protocols Pack!

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References

Adult Speech Therapy

Alisha Kleindel is an instructor of speech-language pathology at Midwestern University with over 15 years of full-time speech therapy work experience. Miwa Aparo is a researcher, editor, and occupational therapist. Chung Hwa Brewer is an SLP and instructor at Western Washington University’s Communication Science Disorders program. More about us →