Originally published on www.voicecouncil.com as part of the World Voice Day series. Click here for the laryngologist, speech therapist and professional singer sides of this discussion http://www.voicecouncil.com/nodules-everything-you-were-afraid-to-ask/
THE VOCAL REHABILITATION COACH'S PERSPECTIVE
The formation of nodules is primarily a condition of the speaking voice, not the singing voice (though the singing voice can aggravate it).
If you have a habitually breathy speaking voice, the back portion of your vocal folds is not closing completely to create a fully sealed valve in the larynx.
This problem is aggravated when you project your voice on a regular basis. This speeds up the process and creates those areas of thickening more rapidly.
I am going to explain why, as a singer and a speaker, you really want a full seal between your vocal folds in the larynx.
What’s Happening in Your Larynx
When the back portions of your larynx don’t “meet”, they vibrate in the breath stream in a different way than the portion of the vocal folds that are closing completely.
The simplest way of thinking about this is that the back portion of the vocal folds are vibrating in a falsetto pattern and the front half is vibrating in a chest or speaking pattern.
The problem is that at the point where the vibrating pattern changes point there is a chaotic sheering effect.
It is at this point where nodules start to form – you develop a thickening around that portion of the vocal fold.
Singing with Nodules
The challenge for singers is that if you can’t get the vocal folds completely closed, you will have a breathy sound (which some singers want).
However, with nodules, you lose the ability to get rid of that breathiness unless you are really belting. In belting you can sometimes force the folds closed.
Actually, some singers find that they belt all day long – but lose the ability to make any high, soft tones at all. You see, with the thickening of the folds that occurs with nodules, they can’t lengthen and thin in the way the need to in order to access those higher pitches.
So, singers with nodules may be able to get a lovely, textured low range and they can belt – but they can’t access other sounds.
The other problem is that excess air tends to dry and irritate your folds. So, people with nodules have a tendency to suffer with vocal fatigue as well.
Voice Rest Doesn’t Solve the Problem
Once nodules are identified, voice rest (resting the singing voice) isn’t going to make a dramatic difference without other direct interventions. The swelling my go down, but resting the voice doesn’t change the habit that produced the nodules in the first place.
In other words, singers go on voice rest – but they don’t stop speaking and singing badly!
In these cases, singers can benefit from some good direct speech therapy to improve vocal fold closure – and any related muscle compensation strategy that may have been introduced along the way such as muscle tension issues in the neck, the pharynx, the tongue and jaw and anywhere else in the body.
A Path Ahead
If I was working in consultation with a singer and a speech therapist, I would look at muscle release techniques for the neck, tongue and jaw. I would reinforce the work on vocal fold closure and good respiratory support (because those things go hand in hand.)
Along with this, I would work with the singer, in time, to extend their pitch and range, looking at techniques for lengthening the vocal folds and increasing the pressure over time so that the air was being used efficiently.
If you are going to have anything go wrong with your voice, pray that it is nodules – since these go away easily and respond well to the strategies outline above. There are some occasions where the nodules become thick and fibrous where they might need to be surgically removed or lessened. Most of the time, however, those lesions will settle down once the behavior in the larynx improves.
If you are a professional singer with a diagnosis of vocal fold nodules be very, very careful before you let any one suggest that they operate on you because when anyone operates there can be scarring – and this scarring can be just as un-pliable as the nodules.
So, surgery should be a last resort – this apples to all small lesions in the larynx that don’t obstruct the airway (polyps, cysts, etc.)
You really want to try therapy first to improve the climate in the larynx; good speech therapy will often improve the climate in the larynx to give you a clearer idea of what you are dealing with.