A tenth grade student with vocal breathiness and hoarseness has been diagnosed with bilateral vocal cord nodules. What is the likely cause?

Bilateral vocal cord nodules, commonly referred to as teacher's nodules or singer's nodules, are typically the result of chronic vocal abuse or misuse. This often occurs due to excessive, forceful, or improper use of the voice over an extended period, leading to irritation and resultant nodule development on the vocal cords.

When a student exhibits vocal breathiness and hoarseness, it suggests that the normal vibration of the vocal cords is being disrupted, which aligns with the changes typically seen with nodules. These conditions are prevalent in individuals who engage in frequent yelling, speaking loudly for prolonged periods, or using an inappropriate pitch, all of which can cause repetitive trauma to the vocal fold tissue.

The other options highlight potential causes of voice disorders but do not specifically align with the development of bilateral vocal cord nodules. Over recruitment of laryngeal muscles could lead to other issues like muscle tension dysphonia but does not directly lead to nodules. A history of recurrent viral infections could contribute to vocal cord swelling but would not be the primary or typical cause of nodules. Similarly, a progressive neurological disease would present with different vocal characteristics, likely affecting coordination and strength rather than causing nodules. Thus, chronic vocal abuse stands out as the