Pre-nodules, Nodules, Acid Reflux and Vocal Care

As every singer knows, we’re only as good as our voices sound on a given day. Whether it’s allergies, fatigue, or a cold– or something more serious– we’re largely at the mercy of our instruments.

The good news is that most voice problems– even the most seemingly troublesome ones– are usually nothing to stress over. Even when we lose our voices, rarely are things so serious as to warrant surgery. Polyps (watery sacs often caused from a single, powerful vocal blowout) and hemorrhages (resulting from the bursting of a blood vessel in a vocal fold) are often exceptions to this rule, but incidents of both are few and far between, and rates of surgical success are extremely high.

Much more common, when it comes to vocal pathology, are vocal nodules and ‘pre-nodules’, which unlike polyps and hemorrhages, are caused from prolonged vocal strain and misuse. Ongoing tension causes swelling of the vocal cords, which in time develops into harder, callous-like growths. These growths interfere with the natural vibration necessary for a healthy vocal sound, resulting in a raspy, throaty tone, particularly in certain areas of the range. Happily, while nodules are sometimes removed surgically, vocal rest, therapy, and retraining usually allows them to diminish, and the vocal cords to return to their healthy state.

If you’re experiencing vocal troubles beyond a normal cold or sore throat, the best first step is to schedule a visit with an Otolaryngologist (ear, nose and throat doctor) who can look at your vocal cords to see exactly what the problem is. If you have voice loss or discomfort, it’s a good idea to rest your voice as much as possible until your appointment. 

One of the most commonly diagnosed voice issue is acid reflux, caused by stomach acid coming back up through the esophageal sphincter and into the larynx, resulting in the reddening and swelling of the vocal cords. Unlike indigestion, many people don't feel reflux, only the symptoms of it... itchy throat, hoarse voice (especially in the morning), and an inability to 'clear the cords'. These issues tend to cause singers to overcompensate by working harder through the ‘thickness’ to produce sound, often in unhealthy ways.

On its own, reflux isn’t usually an issue that will put your voice at risk. That said, any resulting pushing and strain can lead to the creation of pre-nodules, nodules, and other vocal challenges.

As you may already know, there are some purely physical causes of reflux: eating too late, intense exercise after eating, going to bed on a full stomach, too much caffeine, eating spicy and other acidic foods, as well as hormone treatment therapies and birth control pills which loosen the lower esophageal sphincter (Click here for an in depth discussion about the cause and treatment of reflux). In my experience, however, anxiety and acid reflux usually go hand in hand. In fact, I’ve met very few calm, centered people with this issue.

If your doctor discovers that pre-nodules or nodules are present, complete vocal rest for two weeks is a good start to treatment. While this break will help, and sometimes even get rid of the growths, rest won't take care of whatever caused them; working with a voice coach or speech therapist is usually necessary to help you learn how to use your singing voice correctly. They will also help you to discover whether your speaking voice might also be creating problems. Lack of confidence, personal stress, and unexpressed or difficulty expressing emotions can also be huge contributors to vocal challenges, in the singing and speaking voices. 

Fortunately, true vocal pathology isn’t as common as people think; it isn’t the result of normal, powerful, and even prolonged, healthy practice or training. In fact, favoring your voice– going easy on it for fear of causing damage– may often cause more problems than singing in a full, supported, and confident voice. Fear tends to cause not only muscular tension, but for singers to 'pull off their air', thereby restricting the vocal tract and putting undue pressure on the vocal cords. Therefore, whatever vocal troubles you may be having, remember to keep things in perspective. You can handle and heal anything that comes your way. 

*** Click Here to read ***

"Pre-nodules, Acid Reflux and Vocal Care Part 2" 

For more information on the psychology and technicality of voice production, visit Jennifer's website: www.FindingYourVoice.com. Also check out Jennifer's book, The Art of Singing: Discovering and Developing Your True Voice as well as her articles in The Huffington Post and Psychology Today on authentic self-expression and performance. To work with Jennifer in person or on Skype / FaceTime on technical or emotional issues that interfere with your singing and self-expression, visit: www.FindingYourVoice.com.