Vocal fold nodules are benign, typically bilateral mucosal lesions occurring at the junction of the anterior one-third and posterior two-thirds of the vocal folds and are strongly associated with chronic phonotrauma and excessive voice use.¹

They account for a substantial proportion of persistent hoarseness, reported to cause dysphonia in approximately 25% of children and 6% of adults, and are especially prevalent in individuals with high vocal demand such as teachers and singers.²

Despite their frequency, detailed socio-demographic epidemiological patterns remain underreported in many populations. Identification of high-risk groups can help guide preventive vocal health strategies.

MATERIALS AND METHODS

This observational analysis included 204 patients diagnosed with vocal fold nodules in a tertiary-care otorhinolaryngology department.

Inclusion criteria:

• Age 18–59 years
• Diagnosis confirmed on videolaryngoscopy

The following variables were analyzed:

• Age
• Sex
• Occupation

Findings were interpreted descriptively and compared with previously published epidemiological studies.

RESULTS

1. Gender Distribution

Females were affected more frequently than males, with a male-to-female ratio of approximately 1:1.8.

Figure 20:  Pie chart showing gender proportion in study subjects

This female predominance is consistent with prior epidemiological studies demonstrating higher incidence of benign vocal fold lesions in women.³–⁵

Possible explanations include anatomical differences in vocal fold structure, hormonal influences, and behavioral voice-use patterns.⁵

2. Age Distribution

The median age of affected patients was in the third to fourth decade, indicating that vocal fold nodules predominantly affect young and early middle-aged adults.

Previous studies similarly report that benign vocal fold lesions occur most commonly in individuals ≤40 years of age, supporting the concept that VFNs are largely a disorder of the younger working population.³

3. Occupational Distribution

A strong association was observed between vocal fold nodules and occupations involving frequent or excessive voice use.

Table 4: Occupation distribution among study subjects (VFN patients)

High voice-demand occupations

• Homemaker/housewife – 23.5%
• Teacher – 18.6%
• Singer – 10.8%
• Salesman – 5.4%
• Call-centre worker – 3.4%

Moderate voice-use occupations

• Banking jobs – 7.4%
• Students – 6.4%
• IT/corporate/officers – 5.9%
• Industrial workers – 2.5%

Other occupations

• Miscellaneous – 16.1%

Overall, 61.7% of patients belonged to professions with increased vocal load.

Figure 22 : shows pie chart representing study subjects with vocal fold nodule (VFN) in various  high voice demanding jobs and other includes mild to non vocation realted jobs.

Teachers and singers have consistently been identified as high-risk groups for vocal fold nodules due to sustained phonatory demands.¹

Interestingly, homemakers formed the largest affected group in this analysis. Similar findings have been reported in socio-demographic studies of benign mucosal vocal fold lesions, where continuous domestic vocal use contributed significantly to phonotrauma.⁶

Even among individuals without professional voice demand, many reported habitual shouting or prolonged voice use, highlighting behavioral phonotrauma as a key epidemiological factor.¹

DISCUSSION

This analysis demonstrates that vocal fold nodules exhibit clear socio-demographic clustering.

Gender

The observed female predominance aligns with several studies reporting higher rates of benign vocal fold lesions among women.³–⁵

Factors implicated include:

• Thinner lamina propria
• Higher vibratory frequency
• Increased susceptibility to mucosal trauma
• Behavioral and occupational voice use differences

Environmental and psychosocial influences may also contribute.⁵

Age

The peak incidence in young adults likely reflects:

• Greater occupational voice demand
• Increased participation in communication-intensive professions
• Higher frequency of phonotraumatic behavior

This trend mirrors findings from prior epidemiological investigations.³

Occupation

Occupational voice use remains the most consistent epidemiological risk factor for VFNs.

High-risk categories include:

• Teachers
• Singers
• Call-centre workers
• Sales personnel
• Homemakers with continuous domestic voice use

These findings support the widely accepted understanding that chronic phonotrauma is the principal etiological mechanism underlying nodule formation.¹

General Epidemiological Insights

Overall evidence indicates that vocal fold nodules:

• Are among the most common benign vocal fold lesions¹
• Occur predominantly in females³–⁵
• Affect younger working populations³
• Show strong association with occupational and behavioral phonotrauma¹,⁶

Recognition of these epidemiological trends is essential for designing preventive voice-health programs and early intervention strategies.

Limitations

• Hospital-based sample limits generalizability
• Pediatric and elderly populations were excluded
• Vocal load assessment relied on occupational history rather than objective measurement

CONCLUSION

Vocal fold nodules demonstrate distinct socio-demographic and epidemiological patterns:

• Female predominance
• Peak incidence in young to middle-aged adults
• Strong association with voice-intensive occupations
• Significant contribution from behavioral phonotrauma

Targeted vocal hygiene education and early screening in high-risk populations may reduce disease burden and improve outcomes.

REFERENCES

1. Johns MM. Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. Curr Opin Otolaryngol Head Neck Surg. 2003;11(6):456-461.
2. Pedersen M, McGlashan J. Surgical versus non-surgical interventions for vocal cord nodules. Cochrane Database Syst Rev. 2012;(6):CD001934.
3. Milovanovic J, Vukasinovic M, Jotic A, Vlajinac H, Milovanovic A, Pavlovic B, et al. Relationship between socio-demographic characteristics and vocal fold nodules, polyps and oedema. Acta Otorhinolaryngol Ital. 2018;38(5):424-430.
4. Zhukhovitskaya A, Battaglia D, Khosla SM, Murry T, Sulica L. Gender and age in benign vocal fold lesions. Laryngoscope. 2015;125(1):191-196.
5. De Bodt M, Van den Steen L, Mertens F, Raes J, Van Bel L, Heylen L, et al. Characteristics of a dysphonic population referred for voice assessment and therapy. Folia Phoniatr Logop. 2016;67(4):178-186.
6. Rudra RK, Rahman AS, Roy D, Inteshar A. Socio-demographic and occupational factors in benign mucosal vocal fold lesions. Medico Res Chron. 2023;10(2):188-197.