Deborah Aloba - Singing Teacher

Deborah Aloba - Singing Teacher

The Secret is in the Structure

The key to the story of vocal nodules lies in our understanding of the layered structure of the vocal folds. A flexible mucus membrane forms the outer covering of the vocal fold (the epithelium). Beneath are several layers of connective tissue (the Lamina Propria). The outer (superficial) layer is gelatinous in nature and separates the outer (epithelial) cover from the stiffer underlying vocal ligament. Beneath the ligament lies the vocalis muscle. Just to confuse things, the literature often refers to the vocal fold “cover” and “body”, where the cover is considered to include the epithelium and the superficial (gelatinous) layer of the lamina propria, while the body includes the ligament and underlying muscle. In this text I refer to the...

Vocal Surgery – Past & Present

Vocal Surgery – Past & Present

In the past surgery was usually the treatment of choice. Voice therapy was often either unsuccessful (because the nodules had become fibrous scars), given post operatively or not given at all. Surgery to remove vocal nodules often had a bad outcome, giving vocal nodules their reputation of being a “career killer”. Until recently the importance of maintaining the integrity of the gelatinous layer of the Lamina Propria was not fully understood. Surgeons believed removing the swelling and maintaining a straight vocal edge was all that was necessary to restore a clear vocal quality. If the swelling was extensive, the epithelial covering could be “stripped” off the fold. This procedure damaged or destroyed the gelatinous layer so that the...

Vocal Nodules – Treatment Today

Vocal Nodules – Treatment Today

In most cases vocal nodules are treated successfully. Vocal nodules may resolve with rest alone in their acute stage, but if the trauma occurs repeatedly, then treatment will be required. Voice therapy is usually the treatment of first choice. Voice therapy involves vocal exercises that are designed to restore efficient vocal function so that the nodules resolve. These exercises are specifically targeted to deal with the problems identified for each individual during their assessment. If the nodules have become hard however, or if there are time constraints such as specific engagements or training, surgery may be the quickest and most effective solution. Voice therapy is required post operatively to rebalance the voice production and prevent recurrence.

When is a Nodule not a Nodule?

When is a Nodule not a Nodule?

Occasionally the vocal folds develop “nodular” swelling as a result of other conditions, such as vocal fold cysts or scars. These conditions do involve tethering of the epithelial vocal fold cover and do not resolve completely with conservative treatment such as rest and voice therapy. They will require more complex surgery to resolve them. They need careful assessment in a voice clinic to differentiate them from simple vocal nodules.