Vocal nodules are one of the more common—and unwanted—disorders that a singer can experience. We can prevent vocal nodules, and we can learn about
the most effective treatment.
There is a broad range of diseases and abnormal conditions which directly involve the vocal anatomy. In the comments below, you will be helping our community by sharing your experiences with any vocal troubles and/or diagnosed conditions that have impacted your singing. You are in the bests of company here so please do chime in!
Let’s first talk about how you can prevent vocal nodules. The we can explore the best treatment options. Hopefully you will never need this information. However, given how common vocal nodules are, you are wise to keep this information for future reference and to you can share it with others who might need it.
The Emotional Burdens of Live Performance
When your voice isn’t sounding or working normally, deciding whether to cancel is agonizing. You first have to deal with the personal disappointment and likely do without the money from the singing gig. But the other very painful component is knowing that you have let down other people, who want to hear your singing performances.
It is crucial that you not feel isolated and alone. Injuries and other abnormalities of the vocal anatomy that can stop singing in its tracks are an epidemic.
The great opera soprano Jessye Norman said that she never believed in the old saying “the show must go on.” The whole idea creates too much psychological and emotional pressure upon singers. And it is an expectation we all feel obligated to meet. But if you are vocally ill and you give into the pressure to forge ahead with a singing engagement, you place yourself at a much higher risk of falling victim to an abnormality such as vocal nodules.
How to Recognize the Need for an ENT Examination
Please know there are indeed warning signs, leading up to the formation of vocal nodules. It is yet another example of the need for singers to carefully tune into how his or her own body is feeling, particularly with respect to the voice.
For example, let’s say that you normally are able to sing well for an hour or so, before feeling like it is time for a break. One warning sign might present as a loss of vocal stamina. So instead of being able to sing well for about an hour, you would likely begin to detect a loss of stamina after roughly half that time. (This is only an approximation, but you get the drift, right?)
In any event, you would start to experience fatigue, loss of vocal power and beauty, well before the usual length of time that is normal for you to sing.
Recurring Vocal Fatigue
Let’s say the vocal folds are swollen but do not have any vocal nodules. The sound of your voice can still become husky and with a deepness to the timbre, not flattering for your sound. You might discover that the highest notes in your range are more difficult to reach and do not sound as free and as beautiful as is normal for your voice.
Another possible warning sign can be constant vocal fatigue. So even though you have rested your voice for a day or so, it still is not responding normally. The voice might sound and feel thick or difficult to move. You can get the impression that resting the voice did not help.
This means the vocal folds are swollen and fatigued. Instead of responding as usual, the voice feels sort of brittle and stiff. Again there can be an unattractive deepness to the sound quality, while your top range becomes more difficult to access.
Bizarre, Unexplained Vocal Sounds or Sensations
One definite abnormal sign is a kind of noise you might hear, a low-pitched rattling actually accompanying the sound of your voice. Strange! This would be the false vocal folds, reacting to swelling. And if you hear or feel this, please stop singing immediately and make an appointment with a good ENT doctor.
The basic process of making vocal sound (phonation) can become choppy, not smooth as is normal. In other words, the vocal sound skips, stutters, cuts in and cuts out.
Possibly a good way to describe this is to picture yourself standing at the edge of a pond and using a flat stone, tossing it sideways, so the stone skips across the surface of the water. Because of fatigued swollen vocal folds, the voice is unable to respond to the breath in a normal way. So the sound stutters, cuts in and cuts out, somewhat like a skipping stone across a pond.
Any one of these issues are certainly abnormal, terribly frustrating, and upsetting for a singer! Most singers feel anxiety on top of it all, worried and frightened that the voice might be permanently damaged.
This is no time to delay or deny the need for proper medical care.
If you are caught in the grip of any of these troubles, please be examined by a trusted ENT specialist doctor at the earliest availability. The symptoms described above are significant warning signs that you need professional expert care for your voice.
Reason for Optimism
As long as you see your ENT fairly soon, there is an excellent chance of full recovery without permanent damage. Indeed, this is what I have heard ENT doctors say. And it is also my own experience, in working with many singers over the years.
Long-term permanent damage is typically the result of ignoring warning signs and forcing singing to the point that the voice is so beaten up it cannot even phonate. Make no mistake, however: you should not delay in getting to at rusted ENT, as early on as possible, when any of the above difficulties are heard or felt in your singing.
Should you have other symptoms not mentioned here, which you feel strongly are abnormal for your voice and are causing you anxiety, please pay attention to this instinct and see your ENT doctor as quickly as possible. This is always the first and best action which ensures your complete recovery!
Deeply Healing Powers of Hydration and Sleep
In other posts, we realize that good hydration is always the first remedy on a singer’s list. Clean, unflavored water is your primary remedy of prevention and is simply vital for treatment of all vocal disorders. We must drink our water and we must use other forms of hydration as needed.
The doctors like to use the term “over use injury.” Yes, vocal nodules fall into the category of “over use injury,” as does the problem of swollen vocal folds. And whether we want to prevent vocal nodules or swelling, please always remember that getting lots of good sleep is absolutely vital. The voice loves sleep. And there never was, never will be, any substitute for SLEEP!
No Self-Examination of Vocal Anatomy!
Incredibly, I have read on social media that some singers are attempting to use surgical instruments and computer apps, to examine their own vocal folds. In a word: NO!
Please do not attempt any such thing. There are so many reasons this is terribly wrong, it is difficult to know where to start. No question it is one of the worst ideas I have ever encountered.
Talk about permanent damage to the voice! If a person who is not medically trained attempts to insert any type of medical tool or gadget into the throat, there is a huge, dangerous risk of causing serious harm to the vocal anatomy.
Even if a person could do this unassisted, there is the little matter of not having medical training. Thus, you would not be able to recognize what you would be seeing or feeling, during this ”examination.” And if you do not know what you are seeing, there is no way you can make anything close to a valid diagnosis!
It simply cannot and will not work, despite any claim that the process is safe, accurate, effective, etc. Please, if you care at all about your voice, do not attempt to examine your own vocal anatomy!
The Sound of Vocal Nodules
What’s the big deal? Why can’t you keep singing with vocal nodules? Well, first and most importantly the sound of the voice will be badly affected. It will sound thick, husky, coarse, and your high notes will be much more difficult to reach (if you can get to them at all). There is frequently a gravely noise ingrained in the sound of the voice, and there can be a rattling noise, which is a severe form of vocal fry. There might also be a problem in which the vocal sound skips or in other words cuts in and cuts out. This is caused because the thin edges of the vocal cords are swollen and cannot approximate (meet and vibrate together) normally.
I have rarely if ever heard of a popular singer who knew the first thing about vocal health, until their own voices were totally broken down. And in other videos, Mariah Carey, alongside her ENT specialist doctor, they make it clear that the particular vocal nodules she has are too large to be surgically removed. So, yes, she has been left with no choice but to “learn to sing around them.”
Knowledge = Power = Prevention
Please do not allow any trouble with your singing voice persist without being examined by your trusted ENT doctor. “Powering through” singing events always results in damage to the vocal folds, and too often this damage is permanent. Vocal nodules can and do become so large or callused that they cannot be removed.
“Learning to sing around vocal nodules” only goes so far. As the nodules persist, so does the swelling. Thus, you will constantly be re-learning how to “sing around vocal nodules.” Eventually the singing voice will deteriorate to the point that making sound becomes impossible. The voice will be gone!
Blast from the Past: Permanent Vocal Nodules
The legendary American music icon, brilliant trumpeter, fabulously expressive singer, and all-around exemplary natural musician, Louis Armstrong (“Satchmo”), lived from 1912 – 1984. His style of jazz is known as “swing.” Armstrong’s playing, his singing, his whole creative style of communicating, inspired thousands of contemporary musical artists and no doubt will continue to influence generations of musicians.
His signature vocal timbre had a rough gravely quality, which became more pronounced over the years. Here is a clear example of permanent vocal damage.
Here is some helpful background, according to an expert on Quora:
As for Louis Armstrong, according to his biographer Terry Teachout, his voice became raspy due to a prolonged cold, during which he continued to sing. He had two surgeries in the 1930’s to repair the damage and both failed.
The phenomenal case of Louis Armstrong demonstrates how it is possible for some creative genius musicians rise above. We would typically recognize this vocal sound as abnormal and unpleasant to hear. But Armstrong’s singular imaginative style turned the problem on its head, inventing his own unforgettable vocalism.
This is not to advocate vocal nodules as a means of branding yourself as a singer. Louis Armstrong is truly one in a million. Except in the rarest of cases, a physical abnormality that is left untreated will get worse. Armstrong evidently was plagued by chronic health issues. So we probably will never know the extent to which the vocal nodules might have contributed to cutting short his singing career.
The Doctor Is In
Although I have not met this particular doctor, what he is sharing is valuable information, to which I hope you will pay attention.
Surgery ought to be the last resort and only if other treatments fail. When a good ENT performs an exam, photos are taken for you to see. Assuming vocal nodules are clearly seen and diagnosed, and assuming you are satisfied with the quality of the medical care you are receiving, you must follow the doctor’s advice and recommendations.
The main requirement will be vocal rest. About this there is no wiggle room. You must strictly follow the instructions for vocal rest, if you want to get free of vocal nodules. It is imperative to heal the inflammation and swelling on the vocal anatomy. Your doctor might or might not prescribe medications, and one of these could include the corticosteroid drug, Prednisone. Here again, it is critical to follow the dosage instructions. It is also possible that the doctor might give an injection of prednisone, and in this case you probably will not have to take tablets of the medication.
At all times you should keep up your intake of water, at least 90 ounces or more per day, unless otherwise directed by your doctor. And if you allow yourself to sleep well, for at least 8-9 hours per night, this will greatly encourage the body to heal the vocal nodules.
The Role of a Speech Pathologist
Consultation with a good speech pathologist, preferable one that has a special interest in treating singers, can also make a greatly positive difference, toward healing vocal nodules. Your ENT doctor will likely recommend that you have a series of appointments with a speech pathologist and should be able to refer you to one with experience treating singers.
Take this seriously and carefully follow the advice of the speech pathologist. He or she should recommend the amount of vocal rest and also give you some exercises for enabling the vocal folds to meet together normally. Then your voice will be on track to healthy restoration.
Which Natural Remedies Promote Recovery?
Natural remedies can definitely complement your treatment regimen. In this case, you must first obtain permission from your ENT doctor, before using any additional remedies, including all natural remedies as are frequently detailed in this blog.
In general, the most effective natural remedies for reducing inflammation and swelling are:
- Aloe Vera Gel
Follow Dr. Weil’s advice for dosage of aloe vera gel.
- Yerba Maté Tea
- Throat Coat Tea
- Regular adult dose of plain aspirin. Preferred brands are Bayer or St. Joseph, as these were recommended to me by a good medical doctor. He felt strongly that the formulations of Bayer Aspirin and St. Joseph Aspirin were most effective in reducing inflammation. Follow dosage instructions on the label and do not use unless specifically okay with your ENT doctor.
- If you have nasal allergies, COPD, asthma, reflux, or any respiratory disorder that causes excess mucus in your lungs and throat, be sure and discuss this thoroughly with your ENT doctor and with your speech pathologist. The issue here is that repeated throat clearing is irritating to the vocal folds. This is counterproductive, at a time when it is crucial to be reducing inflammation. I advise that you thoroughly discuss these issues with your health care providers, while you are in treatment for recovery from vocal nodules.
- Remedies mentioned in another post, for treating excessive mucus, can be useful. But in this case, while in treatment for vocal nodules, you must first get the okay from your ENT doctor.
This post is for singers suffering from chronic vocal fatigue and/or diagnosed vocal nodules. My hope is to shed light upon a subject of vocal nodules, a vital area of concern for any singer, but not often discussed in a productive way by voice teachers.
As always, your comments are encouraged and most welcome!
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