I had vocal nodules at the beginning of this semester. It was a harrowing journey that I hope I don't have to go through again, yet I am glad it happened sooner rather than later so I could educate myself in a healthy environment.
Resting was so difficult because I wanted to talk to others, but vocal rest required me to be silent. When I did talk, I often felt extremely guilty afterwards. And since I could not talk, I also couldn't sing worship songs. If you ask anyone who knows me, they'll probably tell you that I often sing wherever I go. "There's within my heart a melody" is such a nice hymn and holds true.
What follows is a research paper about vocal health that I wrote in order to cover some of the time lost in my voice lessons. I edited a few things to make it more applicable for this blog (my original paper actually did not have gifs).
I hope you enjoy it!
Getting the best sound out of one’s voice takes practice and training. Choir schools were utilized as early as the middle ages to make sure that young boys who were singing could do so well and efficiently without causing injury to their vocal cords (Wright and Simms). Unfortunately, many music students today do not have regular access to that kind of training and are often unaware or simply do not care about the proper techniques to use. This can cause a number of problems such as vocal cord nodules that are obtained through improper use of one’s vocal cords. There are preventative methods when it comes to getting vocal cord nodules, but if they are contracted, they can be easily treated.
Vocal cord nodules can be compared with calluses, though these are not ones that you want. (American Academy of Otolaryngology–Head and Neck Surgery.) “They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other”. These are not to be confused with polyps or cysts. Polyps are often on one side or the other of the vocal cords and are filled with fluids and cysts are masses that are located within a membrane.
There are many misconceptions about what vocal cord nodules are. The term “nodes” is often used by the masses thanks to the movie Pitch Perfect in which a singer proclaims that she has the aforementioned condition (Moore). Let the records show that having nodes does not allow you to sing bass. The term “nodes” is not necessarily incorrect, but the term most commonly used in a medical setting will be “nodules”. When talking with a Speech and Language Pathologist (a SLP) I would often use the term nodes, but every time would be reminded what the correct term was to use (Quigley). As mentioned previously, having nodules on your vocal cords are not something that can give you a deeper voice, but will in fact harm your vocal cords and eventually make it impossible to sing if there is continued use.
Nodules are not just obtained through improper singing; any kind of vocal abuse can lend itself to getting vocal cord nodules (ASHA).This includes, but is not limited to, harsh talking and loud talking, allergies, tense muscles, and the drinking of caffeine and alcohol. The former substances can still be consumed, but the consumer must be aware of their dehydrating properties which in turn dry out the throat and vocal cords. They do not actually come into contact with the vocal cords, but in fact thicken the secretions within one’s mouth and have dehydrating properties (Henny)(Quigley). Also, women who are between the ages of 20 and 50 years of age are also more at risk for getting nodules on their vocal cords (ASHA). The reason for this is unknown, but means that extra caution must be taken for women who fall within this age bracket. In my case, improper singing may not have been the only, or the main, reason for getting nodules on my vocal cords. Due to the way I talk, the “harsh talking” may have been one of the main ways I got them.
As mentioned previously, these calluses appear on both sides of the vocal cords, which can cause a number of vocal issues. I personally dealt with issues like a loss of overall vocal quality, depleted range, vocal fatigue, and difficulty in creating sound whether it was through speaking or singing. A complete list of symptoms is as follows: “hoarseness, breathiness, a ‘rough’ voice, a ‘scratchy’ voice, harshness, shooting pain from ear to ear, a "lump in the throat" sensation, neck pain, decreased pitch range [and], voice and body fatigue” (ASHA). As you can see, the list is quite extensive and having a few of these symptoms may not be cause for alarm, just caution. For example, it must be noted that symptoms such as hoarseness and a scratchy voice could just be symptoms of laryngitis (Healthwise). Yet this is not something to take lightly. Laryngitis means that one’s vocal cords are swollen. There are a few reasons that vocal cords would be swollen, but improper use could be the main cause. Make sure that you are aware if this happens to you and stop singing. Laryngitis is a precursor to getting vocal cord nodules (Poliniak). This is something I experiences firsthand. Symptoms of laryngitis should only last two weeks or less; any more than that and a physician needs to be seen (Healthwise). If you fear you have laryngitis, drink plenty of water and rest your voice. More about how to rest your voice will be covered later on.
If you fear you may have nodules, then there are a few ways to get properly diagnosed. I did find this tidbit of information: “While various traditional otolaryngologists (ENTs) claim to be “voice doctors”, only a laryngologist has the focused expertise to effectively diagnose and treat the subtleties inherent to vocal health and function. Laryngologists also receive specialized training to recognize rare and commonly misdiagnosed disorders of the voice.” (Reena). It would make sense to see someone was specialized as possible, but if you are not sure about your condition, you may need a few referrals. For my own experience, I had a laryngeal scope put up my nose and down my throat. I have had this done three times. This first time I had it done, I was not able to see what the Ear, Nose, and Throat doctor (ENT) saw. However, the second and third time a laryngoscopy was done by an SLP and I could see what my vocal chords looked like on a screen. A videolaryngoscopy is no more obtrusive than a regular laryngoscopy, but allows both parties to see the vocal cords upon a screen (Chemsian). Though the visualization might be different, the process is the same for a regular laryngoscopy and a videolaryngoscopy.
The procedure is called a “direct flexible laryngoscopy” (Healthwise). When compared with an “indirect laryngoscopy”, the procedure it very different. An indirect laryngoscopy is simply a process by which a qualified physician puts a mirror in the back of your throat to observe your airways. This process is arguably more uncomfortable for the patient and definitely ineffective in viewing ones vocal cords. Due to this fact, a direct flexible laryngoscopy, more specifically called a fiber-optic laryngoscopy, will probably be done. There is nothing on your part to do for a laryngoscopy other than what the specialist tells you during the examination. The ENT or other specialist will most likely use a spray anesthetic up your nose to numb it as well as your throat, but the second and third time this process was done to me nothing was used except lubrication to make the process easier.
The process may sounds scary and obtrusive, but after my initial fright I found the experience to be just slightly uncomfortable. The results may come back fine; it should be noted that a qualified specialist can often diagnose vocal cord nodules by hearing you speak (Quigley). Optimal results are as follows: “your vocal cords do not have scar tissue, growths (tumors), or sign of not moving correctly” (Healthwise). However, if vocal cord nodules are diagnosed, then there are proper steps to take to insure to heal up.
Much to my chagrin, my ENT did not specify specific ways of treatment. She simply said that vocal rest was needed. While this is correct, there are a few specifications that go into vocal rest. It also must be stated that surgery is an option, but should not be the first option. In fact, in a study published in the Journal of Voice “the results of treatment for vocal nodules with or without surgery were comparable and suggested that voice treatment should be the first recommendation for treatment of vocal nodules” (ASHA). This was published in 1992, so obviously the technology has improved drastically, but this should not be one’s only recourse. And even if surgery is done, voice treatment is recommended to “achieve optimal voice”. Voice treatment will be needed regardless, so simple surgery will not accomplish much in the long run. A surgical procedure will only be done if the nodules are quite large and have existed for a longer period of time. The surgeon will go in and remove the nodule form the vocal cord, and then the patient will require a rest period and treatment as instructed by the specialist.
The other two ways of treatment are medically and behaviorally (ASHA). Medication may be used to help in the treatment of inflammation and other issues (Staff, Mayo Clinic). However, the best thing you can do is rest. You may work closely with an SLP or other vocal coach. Vocal rest does not just mean to stop singing—it means complete rest of one’s cords. This means no whispering, singing, clearing one’s throat, or any other behavior that would cause the vocal cords to hit each other. Also, do not discount drinking plenty of water. Through my own personal experience, I remained (mostly) silent for around three weeks. Now, I am currently building back up the muscles required to sing again. All the muscles required for creating sound remained unused for quite some time and sometimes still get fatigued. I was really worried recently that I was getting vocal nodules again due to the feeling I was getting, but my SLP mother told me plainly that I was incorrect and that all the muscles required for singing and talking were simply getting tired from being used in a variety of ways (Quigley). In fact, the process was recorded on video from the videolaryngoscopy and a few pictures from that process are at the end of this report. Vocal health should be taken into account even before something of this caliber happens—it’s never too late to start. There are plenty of preventative measures to take.
Don't worry--taking care of yourself does not make you a dweeb.
In following vocal health guidelines, sometimes the most clichéd rules are truly the best. Before singing, it is important to warm up (Poliniak). This gets you mentally as well as physically prepared. “It gets you back into the same motions for singing, and it also takes the pressure off the lining of the vocal cords, making it less likely to cause friction” (Henny). It should be noted that it can take different times for different people to properly warm up (Poliniak). As mentioned earlier, make sure you are aware of how your body feels. If it is decidedly difficult to sing due to sickness, allergies, or other ailment make sure you take care of yourself and refrain from singing and limit talking. If it hurts to sing, then that is a clue and a good reason to stop singing (Henny).
The importance of water again must be mentioned. A sufficient amount of water is needed to truly stay hydrated. I have found it helpful to set hourly goals for myself and never leave the house without a bottle of water. It is recommended to drink throughout the day as opposed to a large amount in the morning and then nothing for the rest of the day. The amount you need will vary day to day due to a variety of factors. Things like medication, sickness, mouth breathing, caffeine, exercise, humidity in the air, and other such elements will affect the amount of water required for optimal hydration (Poliniak). If you are unsure as to how much you should drink, it is recommended to “drink water until you pee clear” (Henny).
This also factors into to good health choices. These good health choices mean proper rest, which as a college student can definitely be difficult, and avoiding foods that can give you acid reflux. Really it should be states that “Just as a highly tuned athlete treats his or her body with care at all times, so must a musical theater [worship leader, choral member, etc.] performer. Diet, rest, hydration, and good technique are part of a singer's regimen. Combine that with a careful awareness of vocal problems--especially when singing causes pain--and you should have a long and healthy engagement and career” (Henny).
Vocal health is all about research and awareness. I am a testament as to what can happen if one is not aware of their own body and continues to sing through vocal cord inflammation. I am now vocally healthy and continue to implement these practices in my life to make sure I continue to stay that way. If one is aware of how they are singing and what good or bad vocal practices they are implementing in their daily life, they will become a healthier and, in turn, a better singer.
Pictured here are my healthy vocal cords as recorded through a VL thanks to an SLP.
Here are my sources!
American Academy of Otolaryngology–Head and Neck Surgery. Nodules, Polyps, and Cysts: Patient Health Information. 2015. Web. 16 February 2016.
ASHA, American Speech-Language-Hearing Association. Vocal Cord Nodules and Polyps. 2016. Web. 16 February 2016. <http://www.asha.org/public/speech/disorders/NodulesPolyps/#d>.
Chemsian, RV. "Videolaryngoscopy." International Journal of Critical Illness and Injury Science (2014): 35–41. Web.
Healthwise. Cold, Flu, & Cough Health Center: Laryngitis - Topic Overview. 14 November 2014. Web. 18 February 2016.
—. Oral Care: Laryngoscopy. 14 November 2014. Web. 1 March 2016.
Henny, John. "Safe singing: a specialist offers rules for 'athletes of the voice." Back Stage, National ed. (2009): 21. Web.
Pitch Perfect. Dir. Jason Moore. Perf. Anna Camp. 2012. DVD.
Poliniak, Susan. "Music shouldn't hurt: making music is a healthy activity, but it can also cause serious damage if you're not doing it right. Here's how not to get injured." Teaching Music (2011): 38+. Web.
Quigley, Laurie. Speech Language Pathologist Lindsey Quigley. February-March 2016. Verbal.
Reena, Gupta Dr. Vocal Nodules: Diagnosis. n.d. Web. 2 March 2016.
Staff, Mayo Clinic. Diseases and Conditions: Treatment at Mayo Clinic. 19 June 2015. Web. 20 February 2016. <http://www.mayoclinic.org/diseases-conditions/voice-disorders/care-at-mayo-clinic/treatment/con-20036869>.
Wright, Craig and Bryan Simms. Music in Western Civilization. Boston: Schirmer Cengage Learning , 2010.
I hope you liked something a bit more intellectual to read. If you want more of this, let me know! Also, please feel free to contact me if you have any questions!
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