Dr. Jahn, I am a 26 year old male just diagnosed with nodules. The specialist said it was in an early stage. He advised me vocal rest and steam inhalation, and avoiding cold. So far, I have followed his instructions for about a month. My anxiety is how do I know they are healing? I do maintain silence most of the times. Could you kindly give me some advise on this matter. Thank you very much! -Ken
Nodules, or small calluses on the vocal folds, are not uncommon. They are usually the result of chronic vocal misuse. So what I would suggest to you first of all is to look at how are you’ve been using your voice, whether speaking or singing, and with appropriate voice therapy address any abusive habits.
In terms of whether they are healing or not, you can monitor this yourself by trying to sing softly at the top of your voice. If you are able to easily reach the top of your range without excessive pushing and with a very soft dynamic, then the nodules are probably resolving. If you cannot reach your normal top, or if you have to squeeze excessively, or if there is a puff of air that you hear before the voice engages, these are signs that the nodules are still there.
There are many treatments for nodules including voice rest hydration and, sometimes, Cortisone – though this should never be seen as a ‘magic pill’ but is only one form of treatment in some circumstances. Once again, you need to look not just the nodules but what brought them about in the first place.
Another way to look at this is to consider whether you are able to do what you want to or need to as a vocalist. Depending on the genre of music, some singers can function adequately even with small nodules.
When you go to the laryngologist, please ask them to make pictures for you to take home and then you should be able to compare from one visit to the other whether the nodules are improving or resolving.
Dr. Jahn is an internationally renowned otolaryngologist based in Manhattan with a sub-specialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Mount Sinai School of Medicine and Westminster Choir College in Princeton. He is Medical Director at Jazz at Lincoln Center, and former Director of Medical Services at the Metropolitan Opera in New York. Dr. Jahn has published several books for vocalists, including “Vocal Heath for Singers” (Singdaptive) and “The Singer’s Guide to Complete Health” (Oxford University Press).