Nodules, should I get a doctor’s diagnosis?

Weekly Teaching Tip – July 2, 2012

Question: if you are not going to recommend a “medical treatment” and you know what to do as a singing teacher is the best way to help heal the problem – would you still send the student to an ENT to have an official diagnosis? I have heard other teachers say that if you even suspect vocal damage you need to have them go to the doctor so you have proof of a “pre-existing condition” – so it can’t be alleged that you caused any damage. Do we need to know for sure the level of vocal damage or just work the issues as they present using our correct principles?

Answer: The problem with removing nodules is that after you have them removed, the singer should really not do any singing for at least 3 months while the vocal folds fully recover. Then if they start singing incorrectly again the nodules will come right back anyway. My thinking is that if, through proper vocal therapy we can take away the problem that caused the nodule in the first place this is the preferred solution. Not only will the nodule go away with proper vocal therapy and technique, but once it is gone it won’t come back as the singer has also improved their technique!!!

With laser surgery some feel that the singer can get back to singing in a shorter time than 3 months, but I still think the vocal folds need time to recover fully before being put back to use.

Having said that, it is still good to get a diagnosis even though it wouldn’t alter the therapy and my approach to “fixing” the voice. It is good to get the diagnosis to make sure there are not other issues you are not aware of or pathologies that would require medical treatment. It is also good for the singer to hear the diagnosis from a doctor as it scares them a bit and helps them see the importance of changing their habits and makes them more responsive to what you are asking them to do. When they check back in with the doctor later and find that the nodule is diminishing and the vocal folds look better they see the benefit of their work and change and they desire to continue. This is important as most people that have nodules are singing too aggressively and when we help them find a “lighter” coordination, often times they don’t care for this and they want to go back to their “heavier” coordination.