The improvement of the voices of 59 patients following the diagnosis of vocal fold nodules was evaluated according to the type of treatment, i.e., therapy, therapy following surgery, or combined management by an otolaryngologist-speech pathologist. Pre- and post-voice therapy recordings were judged by two experienced listeners and rated on a four-point scale of improvement. Posttreatment judgments indicated that the overall improvement was greatest in the combined management group followed by the group treated by voice therapy only and finally by the group that had the nodules removed prior to treatment. The results of the study suggest that satisfactory improvement of the voice can be obtained using any of the three approaches. Because of potential complications of surgery, the removal of vocal fold nodules is indicated only after other approaches fail to produce the desired results.