Singing Again After Nodules – Advice from a Speech-Language Therapist

Female solo singer
A singing therapist who is also a professional singer shares valuable insights on singing after nodules.

Jackie Presti is a busy singing specialist in New York city. She is also a professional singer and knows, first hand, the demands that singers have to meet.

Singdaptive asked Jackie: what can an SLP (Speech Language Pathologist) do for me to help me sing normally again after nodules?

Answer: The answer to this question can be quite complicated. As with many other professions, not every SLP is “voice therapy” focused. Think about this: You wouldn’t want a plastic surgeon operating on your appendix – but technically, both are MD’s.

SLP’s are licensed and trained to treat many speech, language and voice disorders. However, it is EXTREMELY important to not only find one who is experienced in treating voice disorders (nodules fall into this category) but also specializes in treating singers. Some SLP’s are great working with speakers but may not completely understand the marathon feat of singing. If you can find an SLP who IS a singer, and one who has actually studied voice for many years, I think you will win the lottery. The good news is there are more and more of us around!

In general, SLP’s differ from “traditional” singing teachers (and this is changing as singing teachers are becoming better trained as TEACHERS and not just singers who can sing and then decide they can teach others to do so) in their knowledge of the anatomy and physiology of the voice. An SLP voice specialist can identify the physical muscular tensions (all the surrounding muscles of the larynx, oral cavity – especially your tongue, soft palate, jaw) which may contribute to your resonance problems thus leading you to use excessive force to produce sound, and ultimately causing your vocal fold nodules. Nodules are traditionally categorized as a result of ABUSE and MISUSE of the voice although this is not always 100% true. See below!

Once nodules have healed why do so many singers find that their voice still doesn’t feel or sound “back to normal” and once healed, what are the risks for future injuries without adjusting vocal technique?

Answer: Initially, as you are learning to terminate any abusive physical vocal tensions, redirect your point of resonance and utilize proper breath support, your voice – especially your speaking voice may not sound like the one you’ve been used to. Considering that you had nodules, this is probably a good thing!! If you are a non-classical singer who has not been given the tools to sing the style of music you prefer, this can be problematic. It’s important to work with your therapist in learning how to sing in your particular style without hurting yourself or you will be back to square one in no time. This being said, I have run across singers who have had small nodules for years, and they sing around them because they went through therapy, their vocal technique is solid and they aren’t bothered by them. Rare, but I’ve seen it.

In my practice I am obsessed with getting my voice therapy clients to understand and utilize (after they have been given the “all clear” by their otolaryngologists) their therapy tools IN THEIR SINGING REPERTOIRE. If you go through voice therapy and DO NOT UNDERSTAND what all the strategies and techniques have to do with the type of singing you do, you will not fully benefit from the experience. Which is why I come back to finding an SLP who is a singer and can transition the therapy into your music. Or find a teacher who can continue your journey.

Do all singers suffering from nodules require rehabilitation with an SLP?

Answer: In a perfect world, I believe every singer/speaker can learn how to use their voice in a healthier manner. It just can’t hurt. That being said, sometimes the “perfect storm” can contribute to nodular swellings. It depends on how long they’ve been there, whether they’re soft or hard, etc. I have over the years known many highly trained singers who got sick, continued to work exhaustively, and ended up with soft nodular swellings. They were treated medically by their Otolaryngologists and never had another problem. But many singers do not fall into this category. They have a history of hoarseness, limited range, lengthy recovery periods, etc. This population is most likely in need of both medical and therapeutic intervention.

What are the most common things singers do that cause nodules?

Answer: Nodules generally, (except for the storm mentioned above) develop over a period of time. Singers find themselves increasingly fatiqued after singing, need more and more days of “rest” before they can sing again, and notice that it takes much more laryngeal muscle effort and strain to produce sound. Here are some basic common things that can contribute to all of this

a. Singing in loud environments. No monitors, loud bands and little consideration of when to pull back vocally. Every song cannot be a full out screamer whether you’re singing classical, rock, pop, jazz, etc.
b. No rest. Too much travel, too little sleep.
c. Unhealthy lifestyle choices. Alcohol, drugs, poor diet.
d. Medical issues that can contribute – Singing when sick. When your throat hurts, or you’re coughing a lot – shut up. Sometimes you can sing through nasal congestion.
e. Singing out of your range with little vocal training. You will most likely be pushing hard to get the notes.
f. Not hydrating enough.
g. Medications (both prescription and non) that can dry out the mucousal tissue and contribute to hoarseness, laryngeal changes.

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