Editing Vocal cord nodule (section)

==Diagnosis==
Diagnosing vocal fold nodules typically includes a comprehensive analysis of medical and voice history, a physical examination of the head and neck, perceptual evaluation of voice, and visualization of the vocal folds.<ref name="Johns, M. M">Johns, M. M. (January 01, 2003). Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. Current Opinion in Otolaryngology & Head and Neck Surgery, 11, 6, 456-61.</ref> Visualization is considered to be the main method of diagnosis as perceptual evaluation, which includes acoustic and aerodynamic measures, alone is insufficient.<ref name="Pedersen">Pedersen M, McGlashan J. Surgical versus non-surgical interventions for vocal cord nodules. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD001934. DOI: 10.1002/14651858.CD001934.pub2</ref> Laryngeal videostroboscopy, an imaging technique, is commonly used to view the vocal folds: this procedure can be performed nasally or orally.<ref name="Johns, M. M"/> Vocal fold nodules are most often characterized as bilaterally symmetrical whitish masses,<ref name="Johns, M. M"/> and tend to form at the midpoint of the vocal folds.<ref name="Pedersen"/>

Nodules may prevent complete closure of the [[glottis]], also known as glottal closure, and their presence may lead to an hourglass-shaped glottal closure.<ref name="Johns, M. M"/> Voice problems may result from the presence of vocal fold nodules.<ref name="Verdolini">Verdolini, K., Rosen, C.A., & Branski, R.C. (2014). Classification Manual for Voice Disorders-I. New York, New York: Psychology Press.</ref>  They are diagnosed based on the presence of perceptual features not explicable by other causes.<ref name="Verdolini"/> Such symptoms include: vocal fatigue, breathiness, loss of high pitch notes, lack of vocal control, or increased phonatory effort (i.e. increased effort to produce speech).<ref name="Verdolini"/>