Vocal nodules, microwebs, and surgery.

Successful treatment of vocal nodules is primarily accomplished through the direction of voice-language pathologists and teachers of music and speech. Rarely is surgical treatment necessary, although recent reports have suggested a correlation between vocal nodules and failed voice training with anterior commissure microwebs. One hundred fifteen consecutive patients with vocal nodules were evaluated. Eight anterior commissure microwebs were identified (7%), four of these in performers. Of the 96 patients with sufficient follow-up, 65 (68%) had complete resolution of their nodules and 17 (18%) had sufficient improvement to return to normal vocalization without surgical treatment. Nine patients required surgery, two of these with anterior commissure microwebs. All eight patients with microwebs had resolution of their nodules with either nonsurgical or surgical therapy. In total, 94% of patients were able to return to normal voice function, while the 6% of failures either did not receive or were noncompliant with voice therapy. Microwebs were found to be uncommon in patients with vocal nodules. Microwebs and other laryngeal pathologies in patients with nodules may be associated with a higher incidence of patients failing conservative voice therapy treatment.