Surgery versus non-surgical interventions (voice therapy, medical treatment) for the resolution of vocal cord nodules

Vocal cord nodules are benign, callous-like growths on the vocal cords. Symptoms include hoarseness, throat discomfort, pain and an unstable voice when speaking or singing. They can be caused by 'voice abuse' (prolonged shouting or singing above the individual's own range) but may also be caused by infection, allergy or acid reflux.

Vocal cord nodules can be surgically removed but may also be treated with non-surgical voice therapy interventions (e.g. voice re-training, rest or hygiene advice) or medical/pharmacological treatment of underlying infections, allergy or gastroesophageal reflux.

The authors of this review sought to identify trials which compared surgical with non-surgical treatment. They found that there was not enough evidence to compare surgery to other treatment options. More research is needed.

Authors' conclusions: 

There is a need for high-quality randomised controlled trials to evaluate the effectiveness of surgical and non-surgical treatment of vocal cord nodules.

Read the full abstract...

This is an update of a Cochrane review first published in The Cochrane Library in Issue 2, 2001 and previously updated in 2007 and 2009.

Vocal cord nodules are bilateral, benign, callous-like growths of the mid-portion of the membranous vocal folds. They are of variable size and are characterised histologically by thickening of the epithelium with a variable degree of inflammation in the underlying superficial lamina propria. They characteristically produce hoarseness, discomfort and an unstable voice when speaking or singing.


To assess the effectiveness of surgery versus non-surgical interventions for vocal cord nodules.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 9 April 2012.

Selection criteria: 

Randomised and quasi-randomised trials comparing any surgical intervention for vocal cord nodules with non-surgical treatment or no treatment.

Data collection and analysis: 

No suitable trials were identified.

Main results: 

No studies fulfilled the inclusion criteria.