What are vocal nodules?
Vocal nodules are benign growths that appear on the vocal folds. Nodules are more common in professional voice users like singers, teachers and performers. Females also have a higher risk of getting nodules.
What can cause vocal nodules?
Nodules usually occur after incorrect speaking methods. You can also get nodules due to poor voice projection skills, lots of throat clearing or shouting with force. People who have high voice usage needs are also at risk of nodules. If you speak for long periods without getting enough voice rest, the voice muscle tissue becomes inflamed. Lots of voice trauma puts a lot of pressure on the voice. This leads to tissue changes.
If you rely on voice heavily for work, take a preventative approach.
Vocal warm ups and voice care strategies can prevent damage.
If voice abuse patterns don’t stop, the muscle starts to grow callous like lumps. These lumps are called nodules. At first, vocal nodules are malleable and supple. Ongoing misuse makes the lumps become harder and more fibrous. So it is important to get voice therapy immediately. If you wait too long, the muscle may suffer further damage. Ignoring voice issues can make it harder for speech pathologists to help you recover your voice.
Chronic reflux can also lead to vocal nodules. Reflux causes acid to directly contact the voice muscle. This can increase inflammation and make your voice deteriorate.
I think I have vocal nodules, what should I do?
The earlier you act, the quicker the vocal nodules are likely to resolve. If you have a hoarse voice for more than two weeks, we recommend that you complete a voice assessment.
Voice changes can be indicative of lots of medical conditions. In fact changes in your voice may mean troubles. We don’t want to make you panic but please don’t ignore the signs of voice change.
How do I know if I have vocal nodules?
The diagnosis of nodules involves a team approach and should include:
Voice Assessment by a speech and language pathologist who works as a voice clinician. Not all speech pathologists work actively in voice therapy so choose carefully because you want good outcomes.
Your voice clinician or general practitioner can also refer you to an Ear, Nose and Throat Surgeon for further investigation if required.
Examination by an Ear, Nose and Throat Surgeon with voice specialisation is needed if we need a visual profile of the voice. The surgeon will look at the voice using a camera. If you see an ENT for this process please request a photo or even video of the voice and bring it to your voice therapist.
At Voice Science™ we will assess your voice. This is a detailed examination. The first thing we will do is record your voice. We use the latest voice analysis software that helps us see the way your voice muscle vibrates. When you know how your voice is vibrating we can understand what behaviours are causing the nodules.
Your voice assessment will also investigate other things like:
- how high and low your voice can go
- voice quality: clear, rough, breathy, hoarse, tremor
- projection and voice volume
- breath support and respiration for speaking
- saliva and phlegm concerns
- whether allergies are causing voicing problems
- Why other behaviours like coughing or throat clearing are needed
I damaged my voice at work. What should I do?
Our team works closely with WorkSafe Victoria case managers. Many voice issues are due to occupational risk factors and it is important that your workplace supports healthy voice production. It is recommended to consider opening a Worksafe case if you believe voice problems have been caused at work. Worksafe will advocate for healthy voice recovery and work alongside your employer to ensure a return to work that optimises and guarantees your vocal health and prevent further damage.
What are some typical symptoms of vocal nodules?
The following symptoms are often characteristic of vocal nodules:
- hoarse voice quality
- breathy voice quality
- a “rough” voice
- “husky” voice
- the sensation of a lump in your throat or neck
- pain in the neck region, pain from the larynx up to the ear or down to the chest
- reduced singing range: loss of high notes, inability to access the complete pitch range for speech
- increased vocal fatigue
- voice breaks
- ongoing need to clear the throat
- reduced ability to project the voice (reduced amplitude)
How are vocal nodules treated?
The best approach for nodules is treatment by a voice therapist with qualifications in speech pathology. In most cases a voice therapy program is completed before any surgery or medical measures are considered.
Your voice clinician at Voice Science™ will prescribe voice therapy drills to optimise and repair voice production. You will need to practice voice targets daily. Voice Science™ applies evidence based approaches to the treatment of vocal nodules. All of our methods are backed by current research.
Our goal is to restore your tissue to its original structure and remove the nodules and prevent the need for surgery.
We may also recommend some changes to your work environment to improve acoustics or some voice hygiene strategies to make sure your voice gets to full health.
Will I need surgery for voice nodules?
Only in the worst case scenario, is surgical removal recommended. In many cases nodules will resolve after voice therapy. If you do require voice nodule surgery, it is important to speak to consult a speech pathologist before and after the surgery. This is because in most cases, nodules are caused by incorrect voice usage. Understanding how to get a good surgery outcome will depend on voice therapy techniques. In some cases, nodules return after voice therapy because the behaviour that caused them repeats. A surgeon can remove your nodules but can’t show you how to correctly use your voice to prevent them occurring again. This is where speech pathology is needed.
Read a case study about a teacher with voice nodules here. Learn how how Voice Science™ achieved leading care and service in providing voice therapy for a teacher recover from early stage bilateral vocal nodules.
Voice Science™ provides vocal nodules therapy in Melbourne to local clients. You can book for face to face voice therapy sessions in our Collins street clinic in Melbourne. If you don’t live in Melbourne and want to do voice treatment with us, don’t worry! We also give online voice therapy sessions for clients located elsewhere in Australia or overseas.
Voice Science™ provides evidence based vocal nodules therapy in Melbourne and online as well as at our Canberra Voice Clinic.
Make a query and find out more about our voice therapy 👇🏻
We give tailored care for all voice users. So you don’t need to be a singer or performer with nodules to have voice therapy at our clinic however we do also offer care to professional voice users. Our clinicians special interest in the latest treatment methods for voice recovery.
Words by Voice Science™, 2014 – 2019
Our team are experienced speech pathologists, headed up by our chief speech pathologist, Sarah Lobegeiger de Rodriguez who is a voice clinician and professional opera singer.
University Of Michigan Health System. (2003, April 14). Changes In Your Voice May Mean Trouble, Vocal Health Expert Warns. ScienceDaily. Retrieved February 21, 2019 from www.sciencedaily.com/releases/2003/04/030414084332.htm