Editing Vocal cord nodule (section)

== Signs and symptoms ==

One of the major perceptual signs of vocal fold nodules is a change in the quality of the voice.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /> The voice may be perceived as hoarse,<ref name="Colton et al 2006 Nodules" /><ref name="pmid19779347" /> due to aperiodic vibrations of the vocal folds,<ref name="pmid19779347" /> and may also be perceived as breathy,<ref name="Colton et al 2006 Nodules" /><ref name="pmid19779347" /> due to an incomplete closure of the vocal folds upon [[phonation]].<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="Colton et al 2006 Nodules" /> The degree of hoarseness and breathiness perceived may vary in severity. This variability may be due to the size and firmness of the nodules.<ref name="Colton et al 2006 Nodules" /> Other common symptoms include difficulty producing vocal pitches in the higher range,<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="Colton et al 2006 Nodules" /><ref name="pmid19779347" /> increased phonatory effort,<ref name="Verdolini et al 2014 Vocal Fold Nodules" /> and vocal fatigue.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="pmid19779347" /> There may be a sensation of soreness or pain in the neck, lateral to the [[larynx]],<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="Colton et al 2006 Nodules" /> which generally occurs because of the increased effort needed to produce the voice.<ref name="Verdolini et al 2014 Vocal Fold Nodules" />

=== Acoustic signs ===
Major acoustic signs of vocal fold nodules involve changes in the frequency and the intensity of the voice. The fundamental frequency, an acoustic measure of voice pitch, may be normal. However, the range of pitches the individual is capable of producing may be reduced,<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="Colton et al 2006 Nodules" /> and it may be especially difficult to produce pitches in the higher range.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="Colton et al 2006 Nodules" /><ref name="pmid19779347" /> The intensity of the voice, an acoustic measure of amplitude or loudness, may also be normal.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /> However, the individual's amplitude range may be reduced as well.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="Colton et al 2006 Nodules" /> Perturbations or variations in frequency, known as [[jitter]], and in amplitude, known as shimmer, may be increased.<ref name="Colton et al 2006 Nodules" />

=== Aerodynamic signs ===
If the nodules affect the closure of the vocal folds, airflow levels during speech may be increased in comparison to the speaker's habitual levels. However, airflow levels may still fall within the upper limits of the normal range.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /> The degree to which an individual's airflow levels increase seems to depend on the severity of the injury. Subglottal pressure, the air pressure that is available below the glottis and in the trachea to produce speech, may be increased as well.<ref name="Colton et al 2006 Nodules" />