ated ▁or ▁chron ic ▁mechanical ▁stress ▁is ▁thought ▁to ▁lead ▁to ▁the ▁rem od eling ▁of ▁the ▁super f icial ▁layer ▁of ▁the ▁l am ina ▁prop ria . ▁It ▁is ▁this ▁process ▁of ▁t issue ▁rem od eling ▁that ▁results ▁in ▁the ▁formation ▁of ▁ben ign ▁les ions ▁of ▁the ▁vocal ▁fol ds ▁such ▁as ▁nod ules . ▁ ▁There ▁are ▁several ▁factors ▁that ▁may ▁pre dis pose ▁an ▁individual ▁to ▁vocal ▁fol d ▁nod ules . ▁Activ ities ▁or ▁prof essions ▁that ▁may ▁contribute ▁to ▁ph on ot raum atic ▁behav iors ▁include ▁cheer leading , ▁un tra ined ▁singing , ▁speaking ▁above ▁noise , ▁and ▁teaching ▁without ▁voice ▁ampl ification , ▁as ▁these ▁increase ▁mechanical ▁stress ▁and ▁subsequent ▁vocal ▁fol d ▁tra uma . ▁G ender ▁may ▁be ▁another ▁pre dis pos ing ▁factor , ▁as ▁vocal ▁fol d ▁nod ules ▁occur ▁more ▁frequently ▁in ▁females . ▁The ▁presence ▁of ▁de h yd r ation , ▁resp ir atory ▁in fection , ▁and ▁infl am mat ory ▁factors ▁may ▁also ▁act ▁as ▁pre dis pos ing ▁or ▁ag gra v ating ▁factors . ▁In fl am mat ory ▁factors ▁may ▁include ▁all erg ies , ▁to b acco ▁and ▁alco hol ▁use , ▁l ary ng oph ary n ge al ▁re fl ux , ▁and ▁other ▁environmental ▁influ ences . ▁ ▁Path oph ys i ology ▁ ▁V ocal ▁fol d ▁nod ules ▁often ▁alter ▁the ▁mechanical ▁properties ▁of ▁the ▁vocal ▁fol ds , ▁which ▁can ▁inter f ere