Vocal Fold Nodules: Not a Death Sentence

Vocal fold nodules were the most feared vocal pathology for singers when I was going through my musical education many years ago. There is a stigma within the music community – especially the classically-trained music community- that if you form nodules, you are somehow a weak vocalist. While vocal fold nodules can definitely cause loss of income as a professional voice user, they aren’t the career-ending diagnosis that many fear.

The Science of Vocal Fold Nodules

Vocal fold nodules are essentially calluses on the vocal folds from too much impact stress. They form bilaterally (on both sides) in the mid-membranous anterior 2/3’s of the vocal folds. This is the part of the vocal folds that takes the brunt of the impact stress. Just like a callus forms on your hands from too much stress to that area, vocal nodules can form from vocal misuse/overuse/abuse. To learn more about vocal fold anatomy read this post. 

What Does This Mean for the Voice?

The change in anatomy tends to lead to a reduction in vocal quality (rough, breathy, and sometimes strained). Pitch range is also frequently affected. As you increase pitch, the vocal folds stretch, and that makes the area with the nodules contact earlier. Since this area is stiffer, it doesn’t vibrate well, and that causes pitch breaks and increased breathy vocal quality. Because the vocal nodules contact first, extra air escapes around that area, and the voice is breather. This will also affect breath control because the vocal folds aren’t valving air as well as they should.

How is This Not a Death Sentence?

The number one treatment for vocal nodules is voice therapy – not surgery, not weeks or months of vocal rest. Vocal nodules respond well to therapy. They usually shrink or sometimes practically disappear. Voice therapy is meant to re-align the three subsystems of voicing- respiration, phonation, and resonation (read more about these subsystems here). Voice therapists in the United States are speech pathologists by training. Some speech pathologists are also singing voice specialists. They are trained to rehabilitate singers. Read more about the members of the voice team here.

Bottom Line

If you suspect you have vocal nodules, find a fellowship-trained laryngologist to get a proper diagnosis. The laryngologist will recommend, or help you seek out, a voice-specialized SLP to work with you toward improving your vocal habits – how you use your voice for speaking. A singing voice specialized SLP can also work on improving your singing vocal habits to align with your singing goals. Vocal nodules are not a death sentence. Singers are vocal athletes. As with most athletes, injury is always a possibility. Rehab (voice therapy) is the gold standard treatment for vocal nodules. 

To learn more about vocal nodules from another trusted source check out this site.