Furthermore, in some patients, nodules are associated with severe vocal dysfunction, while in others, the lesions have no apparent functional significance. Consequently, there is no clear consensus among otolaryngologists as to how and when these lesions should be treated surgically.
Many questions remain controversial.
The indications for surgery are varied, and treatment depends upon the otolaryngologist's perceptions and beliefs concerning the answers to the questions posed above. There are three reasons why few otolaryngologists would recommend surgical removal of nodules in children, particularly children under 10 years of age. First, when such nodules are removed, they tend to recur, presumably because the vocal behavior of such children is difficult to modify, that is, the children remain vocally abusive in the postoperative period. Thus, the nodules reform. Second, vocal nodules in children spontaneously resolve in the vast majority of cases.