title: The etiology of vocal fold nodules in adults.
abstract: OBJECTIVE
  To review the recent literature on the etiology and pathophysiology of vocal fold nodules in adults.
  
  
  RESULTS
  Research regarding the etiology of vocal nodules over the past 2 years supports previous thinking regarding the central role of voice misuse, overuse, and phonatory trauma. Advanced modeling techniques have helped elucidate mechanisms by which this may occur such as vibration-induced rise in capillary pressures and varying fluid dynamics in the layered vocal fold structure. Contributory roles of personality traits, reflux, and allergy have also been hypothesized.
  
  
  CONCLUSIONS
  Current research supports long-held beliefs that phonatory trauma is a central cause of vocal fold nodule formation. Innovative basic science research has unraveled mechanisms of traumatic damage and clinical research continues to identify crucial lifestyle behavior and contributing comorbid conditions that play a role in the pathogenesis of vocal fold nodules. The multifactorial etiology of vocal fold nodules requires a comprehensive history to identify contributing factors and a multidisciplinary approach to optimize treatment outcome.
authors.affiliation: Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK. pkarkos@aol.com
authors.forename: Petros D
authors.initials: PD
authors.lastname: Karkos
authors.forename: Maxwell
authors.initials: M
authors.lastname: McCormick
mesh_terms: D000328:Adult; D006801:Humans; D007818:Laryngeal Diseases / Q000209:etiology*; D010699:Phonation; D014827:Vocal Cords