Vocal nodules are phonotraumatic lesions related to voice use patterns. While people who use their voice intensely, such as opera singers, can be affected, vocal nodules can occur in anyone with high vocal demands. Laryngologists from the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery at Baylor explain vocal nodules and how to overcome them.
When you speak, the vocal folds vibrate against one another. Over time, with intense repetitive use, the area where the vocal folds make first contact can become thickened with callous formation.
“We don’t always think about how we use our voice; we just use it. Voice therapists can help people use their voice in a healthy way and decrease the load on the vocal folds,” said Dr. Adam Szymanowski, assistant professor of otolaryngology–head and neck surgery at Baylor.
Voice specialists use hertz to measure how quickly and often the vocal folds vibrate against each other. The average female voice is higher pitched than the average male voice, colliding approximately 200 times each second. A man’s vocal folds vibrate at around 120 times per second.
“The larynx is a valve so when you breathe, your vocal folds open to let air go to your trachea and lungs. When you talk, the vocal folds come together and exhalation causes the vocal folds to vibrate. In order to get clear sound, vocal folds have to meet completely and vibrate freely,” said Dr. Julina Ongkasuwan, professor of otolaryngology–head and neck surgery and chief of laryngology at Baylor. “When you have any lump, bump or lesion on the vocal fold, vocal fold closure can become incomplete, allowing for air escape. The lesions can also dampen vibration. We hear these changes as noise in the sound signal and hoarseness. It can also feel like more effort to talk.”
Individuals with good or efficient vocal technique can prevent and overcome the development of vocal fold nodules or other phonotraumatic lesions. If you have an irregular closure pattern, it takes more diaphragmatic support and airflow to entrain vocal fold vibration. In addition, if you need to get loud, using more airflow is healthier than tightening up your larynx. Vocal fry is an example of a nonefficient voicing technique in which there is little airflow across the larynx and the vocal folds grind on one another.
Symptoms of vocal fold nodules include extra effort when speaking, raspy voice and loss of voice quality. A voice specialist will assess symptoms and underlying causes. Laryngologists work closely with speech language pathologists in a multidisciplinary team approach. Treatment often involves education on voice hygiene as well as individualized voice therapy exercises.
You can implement many voice hygiene techniques on your own. Laryngologists recommend staying hydrated with water and limiting diuretics like coffee and alcohol. Try to limit yelling, shouting and screaming. Acid reflux can exacerbate voice problems. If you have reflux, try lifestyle modifications such as avoiding eating two hours before bedtime, taking antacid before bedtime and avoiding trigger foods. Avoid smoking and vaping as well.
If you plan an event like a big dinner at a loud restaurant with background noise, Szymanowski recommends not to plan it for the same day you plan to use your voice a lot, such as working a full day in clinic or teaching students all day.
“We have a vocal budget – we’re not a battery that has unlimited juice. You have to think about how you’re using your voice and when you’re going to need it,” he said.
Visit your local laryngologist if your voice sounds off and to get rid of the nodules faster. A voice specialist will determine whether you have vocal fold nodules or other benign lesions that are not nodules.
“If you have new, onset hoarseness lasting longer than three weeks, you should see an otolaryngologist for a laryngoscopy to rule out something more nefarious like cancer,” Ongkasuwan said.
Learn more about Baylor Medicine Ear, Nose, and Throat services.
By Homa Warren