Vocal Nodules

Weekly Teaching Tip – June 20, 2016
by Dean Kaelin

Question: Hi Dean, One of my students went to the ENT yesterday and he found 2 small nodules. I told the mom a year ago that they needed to go to the ENT and they finally got around to it. She didn’t have anything noticeably wrong with her voice, I just had a gut feeling about it. Unfortunately, I didn’t press them about going, I just kept asking them if they had made an appointment. Nothing has been painful for her, but lately I’ve noticed her pitch is really off in her second bridge and her high notes have gotten super airy. So again I urged them to go and this is the result. Now, I’m sure all of that is due to the nodules and not just an imbalance of air and muscle. My student is a BIG talker. Probably one of my chattiest and she doesn’t always speak in a healthy way. Her mom has also told me that sometimes she really “belts it out” at home. Oy. The ENT didn’t seem that concerned, according to the parent, and is sending her to an audio therapist to evaluate her speaking and singing voice. He didn’t suggest anything else to do in the meantime, but if she has nodules shouldn’t she be on complete vocal rest? She is currently in a show.

I’ve never had a student with nodules before and I’m not sure the protocol I should follow. And I’m mad at myself for not catching this sooner. I should have been more aggressive about telling them to get to the doctor, but you know how much I love confrontation. Do you have any suggestions?

Answer: Yes, you probably could have been more insistent she should get checked by an ENT, but good catch! I am glad that you were hearing a problem!

Nodules are not necessarily something to be super worried about in and of themselves, however the word strikes fear into the heart of singers and teachers. Usually there is no pain associated since we don’t have nerve endings in the vocal folds. The indication that there are nodules is usually an airy or scratchy quality to the voice, and an inability to get through the bridge (as you have discovered). With vocal rest the nodules will go away, and in pop music they even like nodules as they like that rough, airy sound.

The real problem with nodules is that they indicate improper singing, usually too much pressure or friction on the vocal folds. Think blisters turning into callouses. (And this pressure can lead to other, even more serious problems – vocal hemorage, etc.) Again, the real problem is it is difficult to sing high in the range or get a clear, smooth tone when a singer has nodules. If the singer will stop doing whatever is causing the pressure the nodules will go away by themselves eventually (any time between 3 weeks to 3 months depending how “hard” the nodules are.) There are soft nodules and hard nodules. The soft nodules indicate the singer is doing something wrong, but it hasn’t been so long that it has turned into a callous yet. A hard nodule means it’s been happening for quite a while.

However, simply vocal rest won’t fix the problem because as soon as the singer starts singing (or talking) again, the nodule will come right back if he/she has not fixed whatever was causing the problem in the first place (bad vocal technique, pressure or overuse of the voice). So you know, sometimes the nodule has nothing to do with the way the singer is singing. It may be caused because of muscle tension dysphonia (a fancy name for speaking with too much pressure.) I have students that the only time they aren’t abusing their voice is when they are doing their vocal exercises. They sing too heavy or loud and they talk way too much, with way too much pressure. So I tell them to stop talking, sing minimally and do their exercises often. I recommend they do their vocal exercises at least 4 times a day for about 10 minutes each time. The exercises are like rehab if they do them right. Encourage “hooty” exercises, bubbles, slides, glides,’etc, always going over the 2nd bridge, even if they are cracking. And drink plenty of water and get plenty of vocal rest.

This is something all singers have to be aware of all of their lives, especially with the very aggressive type of singing that pop/rock and broadway want today, but it can even effect classical singers. Again, the problem is often the speaking, so find a good SLP (Speech, Language, Pathologist) if they are forcing the voice while speaking. The SLP will do pretty much what we do with the singing (if they are good), but they work on it from the speaking side mostly and not so much from the singing side – although they will often do slides and glides, etc. This is why it is important to have a team that you are comfortable with. The team consists of the voice teacher, a good ENT (who understands singing – you’d be amazed how many of them don’t), and a good SLP.

Hope that helps.

Dean Kaelin