Catching the nodules early and determining their cause quickly can lessen the impact. Excessive forced use of the voice leads to degeneration of the connective tissue under the mucosa, the cords' surface lining. This becomes a bulge in the surface of the vocal cord fold, causing hoarseness. With repeated stress, the tiny bulge turns into a nodule. It's a vocal cord injury matrix and needs to be recognized as such.
Acid reflux is a frequent cause.
Cancer and airway problems may also cause inflammation. Among singers, screaming rock stars lead the way. This occurs when the two cords don't come together well, and the cords are forced to overwork. Koufman believes that viruses may at the root of some of these. It's almost always in, on, or around the vocal cords.