Vocal Nodules in Children

Definition

Vocal nodules are swellings of the vocal cords due to voice abuse.

Incidence/Age

Vocal nodules are not uncommon and can occur at any age from 2 upwards.

Causes

Excessive strain on vocal cords due to screaming in the younger child and shouting in the older child. This causes minor bleeds into the edges of the vocal cords with consequent thickening.

Symptoms/Signs

The child is usually a shouter or screamer. The main symptom is hoarseness. It is persistent but its severity can be variable. It is often worse if there has been excessive vocal activity on the preceding day. Examination of the larynx is sometimes possible in outpatients and shows the typical appearance of nodules on the junction of the front and middle thirds of both vocal cords.

Complications

The condition is not injurious to health but can cause embarrassment to older children particularly if the voice gives out while talking.

Tests

The most important investigation is examination of the larynx. This is mainly done to exclude other more serious causes of hoarseness, particularly laryngeal papillomas. It is often possible to do this with a mirror or telescope via the mouth or nose in outpatients but a general anaesthetic may be necessary to examine the child's larynx adequately.

Treatment

No treatment may be needed, because the symptoms are relatively minor and the condition is self-limiting.

Other

Voice rest if carried on for long enough, is effective at solving the problem. Speech therapy is also helpful in modifying vocal behaviour particularly in the older child but is not always successful because the habit of voice abuse can be difficult to break.

Surgery

Removal of the nodules via the mouth by the operation of microlaryngoscopy with or without lasering can be helpful, but nodules are prone to recur if the vocal behaviour has not changed.

Outcome

Vocal nodules eventually resolve spontaneously in the majority of children.