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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.