Ivoicet – Elpida Koutsoumpaki

Vocal cord nodules

Vocal fold nodules and vocal fatigue are amongst the most common voice problems.

Both nodules and vocal fatigue, as well as common laryngeal conditions such as vocal fold edema (Greek word that means “swelling”), cysts, polyps, vocal cord varicose veins – occur as a result of prolonged or violent vocal strain. When prolonged vocal strain is established as a habit, the result is frequently a functional imbalance of the vocal mechanism. When the functional imbalance is not supported by efficient voicing techniques, the voice winds up in a vicious cycle between two ends of trauma – at any one moment the voice is pressed, strained, hoarse and tired and at the very next moment it tries to correct this by bouncing to the opposite end and relaxing, eventually winding into loss of intensity and inflexibility and perpetuating the vicious cycle of straining – relaxing, hoarseness and fatigue.

Behaviors such as endless hours of talking without adequate hydration, whispering, role playing (like “the bad wolf” in children’s fairy tales), harsh throat clearing, prolonged screaming, forceful crying or laughing are all behaviors that can strain the vocal mechanism, if it is not protected by appropriate balancing techniques.

Each of the above behaviors is much more likely to be detrimental to the voice and contribute to the development of organic trauma when the speaker is “not well” – if there are emotional difficulties, overwork, sadness, grief, lack of personal time, intense life changes (divorce, retirement), having recently been made redundant, change in personal or professional circumstances, hormonal disorders).  Imbalanced nutrition, lack of exercise, depression, sleep disorders or sleep deficiency,  interpersonal difficulties and stress also contribute to voice stress and the organic problems.

Even more significant will be the effects on the voice when the speaker has to cope with adverse environmental conditions such as large room size, air quality (dust, smoke, spray fumes, chlorine, chemicals), insufficient sound coverage, noise.

Listener behavior is also an important factor in voice abuse. For example, teachers often establish a relationship with students whereby they do not respect  what the teacher says unless she raises the her voice! Teachers also frequently using a harsh or abrupt voice in order to impose discipline. Over time, such vocal behaviors can strain the vocal mechanism, not only directly but also indirectly due to the psycho-emotional burden that accompanies the daily struggle to defend oneself against a difficult audience.

When the first symptoms appear (eg, dry throat, loss of intensity or tonal range, muscle pain in the neck area, dryness or  burning in the throat) there is a tendency for various “treatments” with soothing candies, gargles and blows or antihistamine treatment. These “solutions” often make things worse for voice mechanism. Similar distress is created when e regular schedule is maintained while being ill with flu or asthma, or with a crisis of sinusitis, taking various “medicines” and medications in order to cope with work and personal obligations. Many difficulties with the voice would not even occur if we could comply with our body’s request for rest and recovery time from common ailments such as a common flu.

Of course, the pace of our lives and our professional accomplishments often do not allow for rest. In addition, leave for voice recovery is considered a luxury in most work environments. Therefore, the best thing we can do is to realize the factors that contribute to the problem and to aim for functional lifestyle modifications.

Voice rehabilitation requires substantial and in-depth intervention, both with vocal exercises and with personal development, improving the quality of life and daily choices.

Vocal fold nodules are essentially the result of prolonged mechanical strain on the voice. Absolute voice rest (silence) is seldom necessary, even though it may offer a temporary improvement, and is likely to contribute negatively to other accompanying difficulties, since not being able to speak obviously creates significant practical difficulties! It is only a recommendation for those who are unable to adapt to a voice rest program and are issued instruction for complete voice cessation.  Voice rest with minimal voice use is often a better choice whereby you economize the voice for a short period of time (for 3-10 days, total talk time up to 30 minutes / 24 hours). This can be ideal fir avoiding further strain and facilitating the natural healing process of the body.

It is important to note that in medical terms, vocal fold nodules are not a significant finding, either organically or medically. The nodules are not responsible for the hoarseness of the voice. On the contrary, it is the hoarseness and prolonged imbalance of the voice that creates the nodules. So, even if with a magic wand we immediately made the nodules disappear, the hoarseness and fatigue of the voice would not improve.

The nodules heal and disappear only when the body finds balanced, functional use of the voice. Avoiding behaviors that contributed to the development of the nodules is clearly necessary, but without changing the way (as opposed to the amount) of voice use, often the conditions that led to the appearance of nodules are perpetuated.

Modifying the way we use the voice is not an easy task, as the way we behave in our voice is perfectly intertwined with all our other common, everyday habits. We all know how difficult it is to change any habit, let alone change our vocal habits, which most of us don’t even know. The voice therapist accompanies and trains everyone with techniques that meet the specific vocal requirements of each individual.

The techniques of the integrated Integrated Voice Therapy approach ensure a comfortable, functional and safe sound for every voice need.