- Now without seeking to sound alarmist,
there are so many things that can go wrong
with the human voice.
More often than not, vocal issues are functional,
that is, there can be problems with breath flow,
tension and vocal track shaping.
Occasionally, however, singers and professional voice users,
such as call center workers and classroom teachers
can experience a disturbance in the voice,
known as a vocal pathology.
Today we are going to discuss one such voice pathology,
vocal fold nodules.
- Soundcheck.
Check one, check two.
(happy music)
- Good day my name is Dr Dan
and I'm a contemporary singing voice specialist.
Welcome to voice essentials, where everybody sings.
Now for some today's topic is a scary one.
Vocal fold nodules are probably the most notorious
of vocal pathologies.
Equally they are among the least understood conditions
in the singing community.
As is often the case, poor information can lead to fear
so today I want to dispel the fear
that surrounds vocal fold nodules
by describing what they are,
discussing how they should be treated,
and finally I'll offer some helpful tips
for those of us that have received a diagnosis of nodules.
So firstly what are nodules?
Well let's go to the textbooks
for an ultra clear definition.
The dictionary for the modern singer defines nodules,
sometimes also referred to as nodes as a vocal pathology
in which benign callus like lesions form
on the vocal folds often as a result
of prolonged vocal abuse including poor vocal technique
Yelling, harsh glottal attacks, overuse of the voice,
and poor vocal hygiene.
Let's take a quick look at some nodules
when viewed through a laryngoscope
The first thing that we notice about the nodules
is that they appear in the first third of the vocal fold
and on both sides.
We refer to these as bilateral nodules.
We generally observe nodules in pairs
because the abrasive activity that forms the nodule
is mirrored on both sides of a glottis.
Nodules start out as soft swellings like light bruising
but if left untreated they harden and become callous like.
- Soundcheck
- The person who has well-established nodules
will typically sound hoarse and their voice
will often have an inconsistent breathy phonation.
Essentially the nodules make it near on impossible
for the vocal folds to fully and completely close
what is called adduction.
And when the vocal folds can't fully aduct they leak air
leaving the voice user with a breathy sound.
Now as you might expect the breathiness further exacerbates
the issue by drying the vocal folds out
and reducing the necessary levels of lubrication required
for healthy phonation.
This in turn can lead to a heightening of PTP,
the phonation threshold pressure.
The air pressure needed
to drive the vocal fold's oscillatory patterns.
It just becomes one big negative feedback loop,
and that loop might look something like this.
The singer starts off with improper heavy voicing.
And that in turn then leads to
responsive vocal fold swelling.
Which in turn leads to increased breathy phonation
and that then leads on to
a heightened phonation threshold pressure
which just brings us around full circle
back around to improper heavy voicing.
If the singer or any other voice user for that matter
stays on that merry-go-round too long,
the voice can sustain permanent injury
including vocal fold scarring.
But there is good news, vocal fold nodules
with the help of proper therapeutic intervention
can be treated and remedied,
returning the singer to the full use of their voice.
(applause)
Make no mistake, if the singer does not alter their
vocal habits, including technique and hygiene,
even nodules removed surgically have a high probability
of returning because the systemic issues
that caused the nodules in the first place
have almost certainly not been addressed.
So if you suspect you are suffering from nodules
then I highly recommend that you visit a laryngologist
to have your voice assessed.
It's important to note that other voice pathologies such as
vocal fold cysts can exhibit similar symptoms
to those of nodules.
The only voice care professional that can diagnose
your voice complaint is the laryngologist.
Sometimes called an ears, nose, and throat doctor
or otolaryngologist.
Once you have a diagnosis of nodules,
its important not to panic.
Allow me to dispel an age old myth.
Nodules do not signal the end of your singing career,
not by a long shot.
Yes, you are going to need to take a short time
to rest the voice, adjust your technique,
and rebuild your vocal stamina.
This short journey of three to six months
is best made with a speech therapist
and singing voice specialist working in team together.
The speechy addresses the spoken function,
while the singing voice specialist,
someone like myself, will treat the singing function
of the voice.
Let me be very clear,
the first step when treating nodules
should be voice therapy.
If, after three months of voice therapy
there is no definite improvement,
then surgery may be appropriate.
Remember if you don't address the cause,
the function of the voice,
the nodules are more than likely to return.
I hope today's video has clarified the what, where, and how
of vocal nodules.
Leave me any questions below
and I'll do my very best to answer them.
And if you're looking for some practical activities
to do for a sore and hoarse voice,
then I'll leave a link in the description box below
that'll take you to a couple of my other videos
designed to help heal the singing voice.
But for now I'll sign off, I'm Dr Dan.
Sing well.