Vocal fold nodule

Introduction
A vocal fold nodule (or "Nodules of vocal cords") is a nodule or mass of tissue that grows on the vocal folds (vocal cords). Typically this mass will appear on the anterior one-third of the vocal fold, where contact is most forceful.

A vocal fold nodule reduces or obstructs the ability of the vocal folds to create the rapid changes in air pressure which generate human speech. Symptoms include hoarseness of speech, painful speech production, frequent vocal breaks and reduced vocal range. Females are most likely to develop nodules.

The nodules appear as symmetric swellings on both sides of the vocal folds. The cause of these formations are usually strenuous or abusive voice practices such as yelling and coughing. Persons who are often susceptible are those who use their voice constantly in a loud environment. Examples include cheerleaders, politicians, teachers, musicians and in some instances Marine Corps drill instructors.



Prognosis
The physical impact of having vocal fold nodules does not usually harm one's health, though it can impair one's speaking and singing ability. Perhaps more importantly are the psychological factors when the doctor informs the patient that he/she has nodules. Especially in those who use their voice in their profession (e.g. singers, actors, broadcasters) a nodule can significantly alter the quality of their speech and singing.

Treatment
Treatment usually involves vocal training, speech therapy, and, occasionally, vocal rest. In rare cases, surgery may be required. Removal of vocal fold nodules is a relatively safe and minor surgery. While the patient is subdued under general anesthesia, long thin scissors and knives are used to remove the nodules.

Famous nodule sufferers

 * Luciano Pavarotti developed vocal fold nodules early in his at-the-time mediocre career, leading him to renounce a life of music. Ironically, the psychological release associated with this decision and--soon after--disappearance of the nodules lead to an incredible improvement in his sound quality.


 * One famous sufferer was Queen's pianist and lead singer Freddie Mercury. However, in spite of the fact that he refused to have remedial surgery, he is commonly cited as one of the greatest vocalists ever.


 * Natalie Imbruglia developed nodules during the 90's and had them removed a few years later, this noticably improved the timbre in her voice.


 * A young Lucinda Williams developed and had removed nodules.


 * Julie Andrews also suffered from vocal cord nodules, and famously lost her singing voice after surgery to remove them.


 * Robert Plant, singer of band Led Zeppelin received treatment for nodules in 1973 and possibly 1974. This resulted in a drop in range of voice and a harsh timbre on the 1975 album Physical Graffiti.


 * Bonnie Tyler, In 1977, found out that she had nodules that were so severe that she had to have surgery for their removal. After the surgery was performed, she was ordered to not speak for six weeks. One day while healing, she accidentally screamed and her voice took on a raspy quality.


 * Whitney Houston developed nodules during her famous Bodyguard tour in 1993-1994. At the time, she was unable to rest her voice to prevent permanent damage. She has been able to continue a singing career since then, but her voice has developed a darker and hoarser tone than before.


 * Natalie Dessay, a famous operatic lyric-coloratura, in 2001 underwent surgery to remove nodules and polyps on two of her vocal chords, following vocal difficulties after recovering from a cold. Although the quality of her voice now is debatable by some opera critics and fans, Natalie Dessay has made a complete recovery and continues to perform in opera.


 * 2003 Australian Idol contestant, Cosima De Vito pulled out from the competition after developing throat nodules.


 * Justin Timberlake had surgery to remove vocal nodules in 2005.


 * Omarion, formerly of boy-band B2K also had surgery to remove nodules in 2005, and as a result, had to cancel a number of live shows in London.


 * In March 2005, Blue singer Lee Ryan developed a nodule, and as a consequence had to cancel the boy band's farewell tour.


 * Goo Goo Dolls' lead singer Johnny Rzeznik, Everclear's lead singer Art Alexakis, and Tony Rice, bluegrass's guitarist and singer, all have suffered from the condition.


 * Steve Augeri of the band Journey was forced to leave the band when his nodules got so severe in the 2006 tour, that a replacement was drafted in to continue the tour.


 * In October 2006 Jet guitarist and singer Nic Cester was diagnosed with the disease.


 * Bert McCracken, vocalist of The Used, developed a nodule in his vocal cord, and underwent surgery during the summer of 2007. The nodule was successfully removed.


 * Sonny Moore, vocalist of From First to Last, also had a nodule in his vocal cord. After surgery for its removal, he tore a vocal cord.


 * Joss Stone also had Nodules and was told by doctors that she had to rest her voice otherwise permanent damage could be caused.


 * Oasis lead singer Liam Gallagher is rumoured to suffer from nodules, based upon some of his live performances in recent years.


 * Lisa Origliasso of the Veronicas had surgery in 2006 to remove nodules


 * Angela Gossow, the lead vocalist of Arch Enemy, also suffered from a vocal fold nodule.


 * Tom Keifer, lead singer of the rock band Cinderella developed nodules as a result of his singing voice, a raspy, affected snarl. He underwent repeated surgeries for the disorder.


 * Tedd Webb, a Tampa Bay area radio personality, had his nodule condition diagnosed by a doctor who heard Webb's raspy voice over the air. The doctor phoned him at the station and soon after performed surgery to cure the condition.


 * Billy Lunn (Morgan) lead singer of the subways


 * Brian Joo of Korean boyband Fly to the sky suffered from vocal fold nodule due to a hectic promotion schedule and an over-exertion of his vocal chords.


 * Canadian rock artist Matthew Good was diagnoased with a nodule in the late days of the Matthew Good Band.