Deborah Aloba - Singing Teacher

Deborah Aloba - Singing Teacher

Voice Disorders Information – Vocal Nodules

Voice Disorders Information – Vocal Nodules

What are Vocal Nodules? by Sara Harris (Specialist Speech and Language Therapist and Team member, The Voice Clinic, London) Vocal nodules develop as the result of trauma to the vocal folds. When the vocal folds collide violently swelling can develop around the site of the collision. A single episode of trauma usually recovers over several days of voice rest, but unfortunately, these episodes are often repeated so the swelling becomes more persistent and requires treatment. These swellings are often described as “soft nodules”. If soft nodules are ignored and allowed to progress, the persistent damage may begin to produce fibrous scar tissue. This makes the affected area stiffer and therefore less able to vibrate effectively. These are often referred...

Vocal Nodules – Signs & Symptoms

Initially after the trauma the voice may become “cloudy” (minimally husky) and less responsive over a certain pitch range, losing clarity and brightness. The voice is usually slow to warm up and may sound deeper, breathy and weak, particularly over the upper pitch range. Over time the speaking voice may become noticeably hoarse and breathy. It may also start to “cut out”, around certain notes, giving characteristic “voice breaks”. These are most obvious when the voice is used quietly.  

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...