Vocal nodules are a type of chronic laryngitis that develops gradually from inflammatory lesions. It is also known as singer’s nodule, teacher’s nodule, or shouting nodule if it occurs in children. The typical vocal fold nodule is a symmetrical nodular bulge at the junction of the anterior and middle 1/3 of the vocal folds bilaterally. Etiology] Various causes of chronic laryngitis can cause vocal fold nodules. Inappropriate use of voice and excessive use of voice are likely to be single live extremely important excitatory factors, and the anterior and middle 1/3 junction of the vocal folds have the greatest amplitude at the time of occurrence, thus leading to the formation of nodules there. The disease may also be related to endocrine factors, in childhood, boys are more common than girls, to adolescence are the tendency to self-resolution; adult women incidence and higher than men, 50 years of age or older is less common. Pathology】 According to the development of vocal cord nodules, the pathological changes can be divided into 3 stages. Early vocal fold nodules are stromal water-like, with vascular proliferation and expansion, normal squamous epithelium on the surface, resembling small polyps in appearance, and similar pathological changes to polyps. In the middle stage, there is stromal fibrosis and hyaline degeneration, but the surface squamous epithelium is still normal, and the appearance of vocal fold nodules is more solid at this time. Late stage vocal fold nodules have a similar stroma as the middle stage, but the surface epithelium is thickened and keratinized, and there may be thickened spiny cell layer and incomplete keratinization, and the appearance is pale. Clinical manifestations】 The main symptom is hoarseness. In the early stage, the vocal fatigue and intermittent hoarseness appear whenever the vocal tone is high. When the disease progresses, the hoarseness becomes more severe, from sandy to mute, from intermittent to persistent, and also appears when producing lower pitched sounds. Laryngoscopy shows symmetrical elevation at the junction of the anterior and middle 1/3 of the free edge of the vocal folds. The nodules on both sides of the vocal folds are close together during vocalization, causing poor vocal fold closure. Diagnosis] The diagnosis is made mainly based on the history of hoarseness for a long time and laryngoscopic examination. Treatment】Including vocal training, surgery and drug treatment. 1. Vocal fold rest Early vocal fold nodules can often become smaller or even disappear after proper vocal fold rest. Even if the larger nodules do not disappear, the voice can be improved. 2.Vocal training Vocal training is mainly to change the wrong pronunciation habits. In addition, smoking, drinking alcohol and eating spicy and stimulating food should be avoided. 3.Medication For early vocal fold nodules, on the basis of vocal fold rest, it can be supplemented with Chinese medicine treatment. 4.Surgical excision For vocal fold nodules that are not effective in non-surgical treatment, they can be surgically excised. After surgery, attention should still be paid to the correct method of vocalization, otherwise it is easy to recur. Vocal fold nodules in children usually do not require surgical removal, and can disappear naturally by adolescence.