Editing Vocal cord nodule (section)

== Causes ==
Vocal fold nodules are thought to be the result of vocal fold tissue trauma caused by excessive [[Stress (mechanics)|mechanical stress]].<ref name="Verdolini et al 2014 Vocal Fold Nodules" /><ref name="pmid14631179" /><ref name="pmid19779347" /> During phonation, the vocal folds undergo many forms of mechanical stress. One example of such stress is the impact stress caused by the collision between the left and right vocal fold surfaces during vibration.<ref name="pmid14631179" /> This stress is thought to reach its maximum in the mid-membranous region of the vocal folds, at the junction of the anterior 1/3rd and posterior 2/3rd, the most common site of nodule formation.<ref name="pmid14631179" /><ref name="pmid19779347" /> Vocal overuse (speaking for long periods), abuse (yelling), or misuse (hyperfunction) may produce excessive amounts of mechanical stress by increasing the rate and/or force with which the vocal folds collide. This may lead to trauma that is focalized to the mid-membranous vocal fold<ref name="pmid19779347" /> and subsequent wound formation.<ref name="pmid14631179" /> Repeated or chronic mechanical stress is thought to lead to the remodeling of the superficial layer of the [[lamina propria]].<ref name="pmid19779347" /> It is this process of tissue remodeling that results in the formation of benign lesions of the vocal folds such as nodules.<ref name="pmid14631179" /><ref name="pmid19779347" />

There are several factors that may predispose an individual to vocal fold nodules. Activities or professions that may contribute to phonotraumatic behaviors include cheerleading, untrained singing, speaking above noise, and teaching without voice amplification, as these increase mechanical stress and subsequent vocal fold trauma.<ref name="Verdolini et al 2014 Vocal Fold Nodules" /> Gender may be another predisposing factor, as vocal fold nodules occur more frequently in females.<ref name="pmid19779347" /> The presence of [[dehydration]], [[Respiratory tract infection|respiratory infection]], and [[Inflammation|inflammatory]] factors may also act as predisposing or aggravating factors. Inflammatory factors may include [[Allergy|allergies]], tobacco and alcohol use, [[laryngopharyngeal reflux]], and other environmental influences.<ref name="Verdolini et al 2014 Vocal Fold Nodules" />