Voice therapy and vocal nodules in adults

Purpose of review: This review considers recent and significant information pertinent to voice therapy for vocal nodules. Recent findings: Available evidence suggests that voice therapy directed to excessive, hyperfunctional and maladaptive vocal practices can be effective in improving voice quality and reducing size/extent of pathology. However, there is also a growing literature suggesting that behavioral approaches may not be sufficient to permanently heal tissue changes in some patients, regardless of compliance with treatment aims, due to lasting structural damage in the vocal fold cover. This evidence underscores the need for early identification and education in individuals at risk for nodules. Summary: The relationship between vocal nodules and excessive, phonotraumatic voice use is well established. Voice therapy typically consists of education regarding vocal fold mechanics and etiological factors, as well as modification of specific vocal practices that either cause, exacerbate or result from inappropriate voice production. Therapy can be effective in improving voice quality and tissue health but does not necessarily result in complete resolution of pathology. It should always be considered as a part of the treatment regimen for patients with vocal nodules.