Singing with Nodules | Diagnosis & Treatment | #DrDan ?

– 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.

4 Replies to “Singing with Nodules | Diagnosis & Treatment | #DrDan ?”

  1. i am a singer and have been singer for years but now am failing to sing to because when am singing am catching a cold just after singing for 8 – 10 minutes and its like my voice is closing and opening.

  2. Omg I’m in middle school, and I have these nodules! I had them since December of 2018 and it’s still there! Yes I talk A LOT and all my friends make fun of my voice and sometimes I just want to punch them. Please give me advice!!!!????

  3. Is it possible to have had vocal nodules your whole life? My voice becomes very breathy in mid range & I get crack or air for any higher notes. I also can't scream or shout without crack or just air coming out. I have nice pitch, tone, & vibrato but my range is terrible because of this issue. Have had this my whole life.

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