Nodules?!
May 28, 2019
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Vocal fold nodules are a common vocal fold pathology that cause dysphonia (hoarseness of voice) and are characterized by callus-like growths caused by inefficient vocal use (also considered “abuse”, misuse, and/or overuse of the voice).
Nodules are bilateral (occur in pairs), benign (non-cancerous), symmetrical thickenings that can form into “bumps”. These thickenings are caused by the vocal folds “hitting each other” (vocal fold tissue trauma caused by impact stress of the vocal folds colliding into each other during vibration) and are usually formed at the site of greatest irritation (the midpoint area of the vocal folds). Repeated vocal fold impact stress leads to the remodeling of their most superficial layer and this process results in the development of nodules.
Someone can be more prone to develop vocal fold nodules (or any pathology for that matter) if the vocal folds are swollen, irritated, inflamed, dehydrated, or exposed to irritants. People who use their voices for a living (OCCUPATIONAL VOICE USERS!!), people who shout or use a loud volume frequently, and/or those who work in noisy environments that require voice use over loud noise are at high risk for developing this common pathology.
Symptoms can vary but usually include “hoarseness”, a lower habitual speaking pitch, breathiness, raspiness, increased effort to use voice, difficulty projecting voice, loss of vocal range, vocal fatigue, and specific difficulty speaking or singing at higher pitches. The size of the nodules negatively impacts the resulting dysphonia: the larger the nodules, the greater the vocal fold mass and the lower the habitual pitch will become; the larger the nodules, the greater the extent of incomplete vocal fold closure which results in a breathier voice quality.
If nothing is done at all to change vocal use patterns, nodules can last forever, as they are a USE INJURY and caused by how one uses the voice. Voice rest may help for short-term relief, but voice therapy is the best option for lasting relief and positive vocal change. Voice therapy includes learning the proper ways to take care of, protect, and use the vocal mechanism to heal the current pathologies and prevent any in the future. Surgery is a possibility—but it is not common that a surgeon will opt for this, as the nodules will come right back if the individual has not adjusted their vocal use patterns that likely caused them in the first place. Also, the less the vocal folds can be “cut on”, the better—as every surgery puts the delicate tissues of the vocal folds at risk for scarring. Once vocal patterns and behaviors are changed, the nodules can fully heal within 6-12 weeks depending on their size and an individual’s consistency of exercise practice.
It is crucial to take ownership of your vocal folds, YOUR INSTRUMENT, and take seriously your role in preventing vocal nodules. This role has everything to do with taking care of and using your vocal instrument in the most efficient ways possible in all settings—balancing voice "on" and "off" time to keep you using your voice, just in more healthy and efficient ways. Want to learn how? Look for a licensed and certified speech pathologist who specializes in voice...
