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Vocal Nodule

I just got back from a visit with an ear, nose and throat specialist. THANK GOD there are doctors out there for us, who understand us choir people. She said I have a small nodule on the left vocal cord. And obviously school starts soon and I'm at a new school. Vocal rest is very important, but anything else you suggest?
Replies (13): Threaded | Chronological
on August 27, 2015 3:42pm
Hi Ben,
 
I am the spouse of an ENT...so thank you...sometimes Hubby doesn't feel appreciated! 
 
Vocal rest is important but watch what you eat and when you eat it.  Acid reflux is a very real (often)contributor to nodes, and can irritate them or make them worse.  Spicy or acidy foods close to bedtime are a no-no.  Watch your citrus juice comsumption (close to bedtime) and it's not just orange or grapefruit juice but CRANBERRY juice too!  Your ENT can give you a list of foods...or I'm sure you can Google it......to avoid until things resolve in regards to the node.
 
Good Luck,
 
Marie
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on August 27, 2015 4:36pm
I had this happen too.   You may have to visit a speech therapist a few times, and identify the speaking patterns that can cause tiny stress tears that build up over time.  Choir directors often use their voices to throw out corrections to the choir, despite our conducting teacher's admonitions NOT to do this.  It's a bad habit and is vocally harmful to us!   I had to change my eating habits, and start taking GERD medications.   My latest favorite is Cimetidine, available without a prescription at the grocery store.  You can fix this but it will take some time.  Good luck! 
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on August 28, 2015 3:47am
Music teacher/speech therapist weighing in. 
 
Instead of waiting for a recommendation for a voice evaluation by a speech/language pathologist, REQUEST one. Your ENT will most likely appreciate and comply with your request. Specifically request the evaluation be done by a therapist who specializes in problems of voice. 
 
Don't attempt to cut corners- the SLP MUST have a CCC credential from The American Speech/Hearing/Language Association. Your insurance will hopefully cover services recommended by your ENT.
 
The concept of "vocal rest" may seem simple, but depending on what is happening in your larynx, it may need to be part of a process of re-learning how to use your voice in a healthy way. If so, you will need to be aware of what caused the nodule and strategies to keep the situation from happening again.
 
If you are taking ANY medications that may cause drying, especially antihistamines or decongestants, be aware that laryngeal tissues are extremely sensitive to drying, so that you must constantly re-hydrate. Again, your ENT can help you with this.
 
 
 
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on August 28, 2015 3:52am
I was fortunate to not reach the point of having a nodule, but came close and speaking and singing became uncomfortable. I worked with a speech therapist who worked with me on raising my speaking pitch back to my normal range. It seems that it is very common for teachers to lower the pitch of their voice which puts stress on the cords - usually because of speaking while stressed or not supporting the speaking voice which needs the same kind of support as the singing voice does. I also, years later, lost my voice completely because of acid reflux - different issue, different fix. Thank goodness for good ENTs who recognized what the issue was in both cases.
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on August 28, 2015 6:07am
It will be tough to rest your voice while teaching.  Have you thought of getting a small microphone to use?  There are completely portable body mikes ( I forget the correct name) that could be extremely helpful.  Many exercise instructors use them and I have often seen them used in large choral rehearsals.  I believe they can connect through a simple stereo system.  I have seen them discussed on choralnet as well so a search might give you the name to look for or someone else might know and can respond.  I also lost my voice but did not develop a node due to classroom teaching.  It took three months of rest and very little singing to recover.  Reflux can definitely be a big part of this so all the posts about that should be followed as well. 
Does anyone know the name of the wireless mikes most teachers use?
Catherine
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on August 29, 2015 7:38am
Mic's are great. I don't have access to a portable mic. I do a lot from my keyboard, so I have a standard boom stand and mic. It has made a lot of difference on the wear and tear is my voice. 
on August 29, 2015 9:45am
I use the Chattervox. It is a personal amplification system that uses a headset and speaker on a belt around my waist. I will admit that I do not especially like having to wear it but it is very powerful and effective. I keep the volume turned up very high - let it do the work rather than fatiguing my voice! - and speak extremely softly. 
 
Incidentally, I purchased it myself - about $200. Was not about to further endanger my own vocal health waiting for my district to buy it. I have also experienced vocal damage - never to the point of nodules - but had chronic vocal problems with speaking and singing. I enlisted the help of an experienced vocal specialist with a Ph.D in voice disorders at Cleveland Clinic, and he taught me to rehabilitate my voice and prevent this problem from happening again.
 
Also, in my case, an ENT misdiagnosed acid reflux and I took meds for this condition for years. My voice specialist explained that this is often a default diagnosis when the true source of the problem is vocal abuse - misuse and overuse - which an ENT may not have the training to diagnose. On the other hand, a true case of reflux can contribute and must be controlled through diet at the very least.
 
Voice issues are serious and seldom correct themselves. You will need to be diligent. Good luck to you.
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on September 27, 2015 2:14pm
Be careful of the speaker set-up when using personal mics. It's not so good if the sound of your voice comes from a speaker in a different location than your position. I used to have to team-teach PE once a week. The personal mic moved with me, but the speaker was in a fixed position. With the unembodied voice the kids didn't focus well at all. The speaker needs to be very close to you. The system Suzanne describes sounds ideal.
on August 28, 2015 8:12am
I second Catherine's suggestion!  Having your voice amplified will help immensely until the nodule goes away.  You might also try silent rehearsals with your students, where your instructions are given by purely visual cues.  (You might have to talk a little, but you can minimize it.)  They might enjoy the "game" and pay close attention to your gestures, while you get to rest your voice at the same time. 
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on August 29, 2015 8:21am
Ben,
Hopefully you are resting going into the start of school.  
I lost my lower register about 10 years ago due to reflux and other issues related to teaching.  I have recovered it and am singing in operas in my retirement while still teaching periodically.  I have warm-ups specifically for this purpose.  Please email me for more details.
Drink Warm-Water first thing in the morning and through-out the day. Especially when you feel like clearing throat-DON'T!!!, Drink-instead.
Make sure you ask your ENT for a mic request. The district will have to pay for one of your choosing.  I work with a band guy who has a great wireless mic installed system in his room he can even use from within his office. Let me know if I may be of service.
Dave
 
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on August 30, 2015 8:25am
I agree with Suzanne--waiting for the school district to buy you a mic is not worth the $200 you would spend on a Chattervox.  There are other cheaper mics out there, but they seem to not last as long.  I used my first Chattervox for 10-12 years and am now on Chattervox #2.  You can google it and buy online.  I also think Charles 'silent rehearsals' with a lot of writing on the board is a great idea.  At the beginning of the school year, the students might get into some good habits that continue all year--and feel like it's a game.
 
Do get some proper speech therapy!
Best,
Eloise Porter
voice101(a)gmail.com
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on August 30, 2015 3:07pm
I agree that Chattervox can be very helpful.  Also, YES, get some speech therapy from a fully-qualified SLP who is interested in dealing with phonation.
 
However, when you say "a small nodule," it makes me cautious, because the way I learned it, nodules usually occur in pairs, if by nodule you mean a callous-like lesion on the superficial lamina propria of the vocal cord.  If you do indeed have a single nodule, then taking it easy on your voice and learning better vocal technique will probably cause it to resolve.  However, if your doctor is using "nodule" to mean "a bump" that could be a cyst or a polyp, then it may be that therapy and behavioral changes alone will not do the trick.
 
Was your exam videoed?  If so, you can ask your doctor to send a DVD and written report to the SLP you choose, and the SLP will be able to understand the report and explain to you in more detail what is going on and what needs to happen.  
 
After the SLP says you're done, if you don't FEEL done, you may want to look for a "Singing Voice Specialist," who can get you the rest of the way there.  Some ENTs and SLPs have singing voice specialists they work with, although this is a new model and not customary everywhere.
 
Meanwhile, here are a few suggestions that are good for preserving your voice no matter what:
- Don't habitually sing along with your choir.
- Really don't sing along with a voice part other than your own.
- Really, REALLY don't sing along loudly for a long time with a voice part other than your own.
- Develop a bag of tricks for commanding silence in the room, then use it!  WAIT FOR COMPLETE SILENCE before speaking.  Even when you are in a hurry.  Maybe ESPECIALLY when you are in a hurry.
 
Good luck!
Jay Lane
McClosky Institute of Voice
 
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on September 24, 2015 9:02pm
No whispering, unless it's voiced, as in talking softly, easily. Prevention is the key. Too much tension when talking is usually the cause and not singing style, as your vocal use is the same in talking and singing.  Spend time in voice practice by SPEAKING: read the paper or an assignment: chew gawdily, open-mouthed, with continual tongue movement while reading to minimize tension build up not only in the voice cavity (mouth/jaw), but this also helps relax the actual vocal chords--they just won't adduct (Close) as harshly.  It's THAT tension, when first making sound--whether speaking or singing or laughing--that dictates the balance of Tension and Relaxation.  You will transfer any bad habits from speech to singing.  So start sound with airflow first.
**Practice the Yawn-Sigh  'Haaah' DOWNWARD, not upward, in speech, later with singing. This will ensure the breath precedes the sound, minimizinig tension and maximizing relaxation of ALL affected muscle groups.  Thank you to my late husband Roland Wyatt for his insight into speech and singng therapy.  (He recorded voice lessons with The Manhattan Transfer called Guideposts to Sinigng, now on CD format).
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