Vocal Health

Vocal Nodules and Vocal Health The vocal cords are a soft V-shaped tissue that is housed in the upper part of the windpipe known as the trachea. This tissue measuring only 11-17mm in females and 15-23mm in males generates the sound we use for speech. (1) The phenomenon of speech, called phonation begins with breathing air. As air is exhaled and travels up the trachea, the cords are brought together by connected cartilage called the arytenoids, making the vocal cords tenser and slightly longer.

Once the air from the lungs reaches under the closed cords, pressure begins to build up and eventually pressure becomes high enough to blow the vocal cords apart and allow a burst of air to pass through. The vocal cords return to the closed position afterward due to their elastic nature. The cycle begins again and repeats hundreds of times per second in speech, causing a wave-like vibration to occur in the folds.

These vibrations generate an acoustic signal that is then transmitted to the throat, chest, pharyngeal, and head resonators to produce the voice. (2)

Vocal Nodules and other Vocal Issues

Like any other muscle in the body, the vocal cords can be misused, overused, and abused. Vocal misuse or overuse can cause benign lesions like vocal nodules, polyps, and cysts to grow on the vocal cords. (3) These lesions alter the quality of the voice and can cause hoarseness, vocal fatigue, a throat pain, low-pitched voice, or an airy voice. (4) Teachers, singers, and professionals who use their voice for a living are the most prone to develop lesions, especially vocal nodules.

Vocal nodules are characterized by inflammation and a thickening of the vocal cords that produces a small bump in the affected area. (5)  Vocal nodules seem to be a common problem among teachers and females in general. A study conducted in Spain found the presence of vocal nodules in 43% of female teachers with dysphonia. (5)

Another study done in Belgium found that the majority (7/10) of patients who visited a voice clinic for difficulty speaking (dysphonia) were adult females. (6) One in five women in the workforce were found to have vocal nodules as well. (6)

The good news about vocal nodules and other vocal lesions is they can resolve on their own with vocal rest and practice of proper vocal technique and training. Surgery can also be performed to remove the lesion as a quick fix option but should be paired with vocal therapy to ensure lesions don’t come back.

Vocal surgery is not without risks however. The iconic Hollywood star Julie Andrews known for her roles as Mary Poppins and Maria in Sound of Music suffered permanent vocal damage after a botched vocal polyp surgery that left her unable to sing high and hold out notes. (7)

Proper Vocal Use

So what can you do to take care of your voice to prevent vocal lesions? First don’t abuse your voice. Avoid yelling and screaming. If your voice feels tired after talking for a long time, take a break. Bad habits like excessive throat clearing and coughing can also irritate the voice. Try to avoid these habits as much as possible.

Second, make sure you are using your voice properly. Most vocal issues like hoarseness, throat pain, vocal fatigue, and dysphonia stem from placing the voice in the lower throat. Dr. Morton Cooper, a pioneer in speech pathology and voice coach to Hollywood celebrities in the late 80s, reported hundreds of cases of vocal issues, particularly spasmodic dysphonia, cured after training patients to bring their voices out of the lower throat and into the upper throat.

The proper vocal placement is in fact, in the upper throat, the upper two-thirds of the face around the lips and the nose, commonly referred to as the mask. This mask voice has the most resonance and is the best voice for speech. The easiest way to feel the the mask voice is to hum a simple tune like “Happy Birthday.” If you are humming correctly you should feel a slight buzzing sensation around the lips and nose. This the area you should place your voice when talking.

If you aren’t sure you are humming correctly you can try the “voice press” method developed by Dr. Morton Cooper. Take your index and middle finger and place them on the fleshy part of your stomach at the bottom of the sternum underneath the chest. Relax. Now, simultaneously hum as in “Hmmm,” and press on the area in a quick repetitive fashion. Your voice should shake like you’re riding a bicycle down a bumpy hill. Also, each press should cause the voice to become a bit louder. This should be your natural pitch.

Now try humming without the voice press. Count to 20. Again, you should feel a slight vibration around your lips and nose. Get used to this sensation and practice it until it becomes easy. If you catch yourself dropping your voice to the lower throat, go back to humming and use the “voice press” until you feel a tingly sensation in the mask area and then try speaking again.

Another crucial aspect to proper voice use is breathing with the diaphragm. Take a minute to stand sideways and observe yourself in the mirror as you breath. Your stomach should rise and stick out when you inhale and go back in when you exhale.

A classic sign of improper breathing is an up and down movement in the chest and shoulders. This can create tension in the throat and lead to difficulty talking and even swallowing. If it is difficult for you to project your voice from the upper throat, vocal training with a speech pathologist may help.

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